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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No.25121 DATE <br />: �.s` <br />Service Address�i ��/�..�._�� ��� Utility Account <br />CHART N0. <br />SF�i To Cf./A�'Ti.�. - 7//'�� 8,7 <br />Billing Address I �`-�' �� / Permit Fee `�lJ � v�/ <br />City, State, Zip � � � ' � � � Connection Charge�s) <br />Owner (Mortgagor) .�N ���1�tlijQ Total Fee_ ,�v � � � <br />Billing Name i� ��/�����_ Sew�'��e� �e� �J� �� <br />n ,,,, , D 9g`f s'3 <br />Cnnnection <br />Phone � `� /� � / �/// <br />DESCRIPTION: <br />Lot <br />%(i�d �/i1i47�/d,O�I�' � <br />� � <br />.. •. �• . . <br />Signed _ <br />Sewer Disti <br />SEE SKETCH ATTACHED <br />INSP[CTIGN <br />'� � <br />'�. . . <br />Monthly Sewer Servi <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engincer <br />I ssu ed <br />Inspection By <br />�� <br />Date lnspected �' � �� <br />No. 25125 <br />