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everett <br />� � <br />I <br />� City of Everett <br />� Se�nrer A lication and Permif <br />� PP <br />� No. 23080 <br />IService Address_ <br />� Billing Address_ <br />City, State, Zip._ <br />i Owner (Mort i ory_ <br />9� 9 <br />Billing Name <br />, Connection By_ <br />� Address <br />' Phone <br />' DESCRIPTION: <br />Lot <br />Plat _ <br />' Unplatted Descriptic <br />i <br />ii Type Permit: , <br />Block_ <br />�'�,�f, ,. t-ir/ H .�- G ��r�,�, „!�'.L. <br />. . ,. . -.-. i <br />; � <br />-- =-- -- —�' l -- — -- <br />I <br />I �SEE SKETCH ATTACHED <br />I CHART NO. � "��G� - � � �_ <br />� � --__ �_ <br />, t�-.sicD <br />Utility Account No.__ <br />Permit Fee <br />Connection Charge�s) _ <br />Total Fee _ _ _ <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />"irunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Gty Engmeer . <br />i� <br />Inspection By ��-���/��2:-5<n I�f'" -- <br />Date Inspected_ �' /'% ___ <br />No. 23oso <br />