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evereri <br />� <br />City of Everett <br />5ewer Application and P�rmit <br />No. 25278 9 Z DATE .� ��__ <br />3 � <br />Servi:e Address _ � %7� � �� � C1 <br />Billing Address. <br />City, State. Zio <br />Owner <br />Billing <br />Connec <br />Phone_ n�✓`�/ � �%��,r <br />CHART <br />Utility Account No. <br />a S�' <br />Permit Fee_ _ o� <br />Connection <br />5-Y' <br />7otai <br />Signed <br />Co;�omvr <br />DESCRIPTI�: Sewer District <br />Lot���1_� � /5 glock <br />Plat �� J �A �� Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPLCTION <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />APP�nved By'—'!_L� /��ci <br />City Engineer <br />ISSUCd By ��• / _� <br />Inspection By <br />)ate I <br />�bC_l.v�A -� <br />No. 25278 <br />