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r <br />everett <br />� <br />City of Everett <br />Sewer Application arad Permit <br />N�• 24470 DATE �� <br />ServiceAddress �.�-� � f//�G, `L_ <br />BillingAddress �e'Z�?r� /y���/! � <br />City, State, Zip��i/I �"C p `,�j <br />��,��. <br />Uwner (Mortgagorj �C�� <br />Billing Name �1� _ p <br />Connection By � - � �i,_���� <br />Phone_ ���-' %�b�/ <br />DESCRIPTION: <br />Lot Js�!�xa�a Block <br />Plat �' <br />r H � �"O � <br />Unplatted Description <br />Utility Account No. <br />d� <br />Permit Fee__ i0' <br />Connection <br />o_� — <br />Total Fee ��O <br />/" �, <br />� <br />i <br />Signed -,•' � __,:. . _.--- <br />— Customer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />4pproved By l( • (i�' . /�iL,� <br />Ciry E inecr —' <br />ssued By n/ • � f� <br />nspection <br />iate I <br />rvo. 2�470 <br />� <br />