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� <br />� <br />ev ��rett <br />� <br />City of Everett <br />S�wrer Application and Permit <br />N0. Z4258 DATE `/ / -.. _ L <br />Seroice Address f Utility Account N <br />Billing Address -� �- //' � Permit Fee <br />City, S[ate, Zip � � Connection Charg <br />Owner �Mortgagor) � J <br />-� Total Fee <br />Billing Name <br />. <br />Connection By __,. <br />— ' � ��' '� <br />DESCRIPTION: <br />Lot �� -� Block <br />Plat i i - _ <br />Unplatted Description_ <br />Type Permit: - — <br />CHART <br />(s) <br />r .• . . <br />Sign�d <br />cu:tomcr <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District r L <br />Monthly Sewer Service_ , � r� <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By � / <br />Ciry Engrnect <br />I ssu ed <br />Inspection By ��,: _ � <br />)ate I nspected ��, �Z� ,� <br />/lo NO. Z���H <br />-1 <br />