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(everell <br />City of Everett <br />F.;tgineering & Community Services <br />Sewer Application and Permit <br />No. 21722 DATE +� -' / <br />Service Address 3 5 / v /fJ <br />Billing Address- .5ikl i--- <br />City, State, Zip_e VI iZG , %" IA// A(- G1F.Ad/ <br />Owner (Mortgagor) T) IT iJ /t/iEGi 5 <br />Piling Name : <br />Connection By Ci T % O F•,/� j� —7-•�' <br />r <br />CHART NO-le� :3Q - y - E — <br />Utility Account No. <br />Permit Fee /•/J <br />Connectia : <br />Total FrAA//,) FCC <br />Signet —,6.t le-- &j�!(" <br />Customer <br />DESC(iIPTION: Sewer District <br />Lot Z 6 <br />Block_ S <br />Plat t n'f Ora V S / " {�)� Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />. t4 i Z <br />Remarks: <br />s.<. <br />Z� <br />a <br />--- I <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />I. N, S, E, IN.. <br />Approved By <br />Cfty Engineer <br />I sued By <br />Inspection By <br />)ate Inspected y-- 9 - 7 7 <br />No. 21 1 22 <br />