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CHART NO. If / Z Z8-(l <br />everett <br />,,e <br />City of Everett <br />Sewer Application and Permit <br />No. 23039 q�8q/g DATE — rf ' 7 2 L <br />Service Address (�'/ 'y"�a4 /itltility Account No <br />Billina Address . Permit Fee <br />City, S <br />Owner <br />Billing <br />Conner <br />Address <br />Phone gg: '� l"e % <br />DESCRIPTION: <br />Lot Block �B <br />Plat{/ <br />Unplatted D ription <br />SEE SKETCH ATTACHED <br />s—ir - 2.5 <br />Connection Charge(s) <br />a� <br />Total Fee O <br />Signed_ <br />Customer <br />INSPECTION <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting i_ot Line <br />N, S, E, W <br />Approved By <br />ity Engineer <br />Issued By. <br />Inspection By—�GJ <br />Date I nspected_ � -S -7 <br />No. 23039 <br />