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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. '�� — a� `� <br />�'- -'-�--�c'-C <br />. . � � � — ! J <br />�/ �.. <br />�� �/ % <br />/n' � <br />/�� � <br />/�-.�; . <br />No. 23091 DATE _ '� � <br />Sen�ice Address .~� �� �/%l�y�%� fr��• �--- Utiliry Account No. <br />Billing Address Permit Fee_ <br />City, State, Zip Connection Charge(s)_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By ''l <br />Signed ___—.— <br />Cuslomcr <br />Phone l <br />DESCRIPTION: <br />Lot B�ock ' / <br />Plat <br />Unplatted Description <br />Tvna Parmit• , . . <br />SEE SKETCH ATTACHED <br />S?ECI;. <br />Sewer District _ <br />Monthly Sewer Service_ <br />Monthly Sewcr Constr. <br />Abutting Lot Line <br />N, S, F., 1N. <br />Approved By <br />City En�jinecr <br />Issued Bv � <br />Inspection <br />Datelnsoe <br />NO. ��UJ�, <br />