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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />No. 23831 <br />3931 Hovt <br />Service Address_ <br />Fiilling Address— <br />City, State, Zip_ <br />Owner (Mortgagor� <br />Billing Namp_ <br />Connection By_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />U�platted Descr <br />Type Permit: <br />DATE Dacamb�z 3, 1980 <br />City of Everett <br />Block <br />RernarkSt `S, �� , , �, ,�,/ r 7; : "'.= <br />��' � f, ��' _�5!' .. �, <br />,,. <br />y� �� = �- <br />SEE SKETCH ATTACHED <br />CHART N0. Z �-z� -5 <br />�' GI " � <br />/ (,\ � <br />Utility Account No. _ <br />None <br />Permit Fee <br />Connection Charge(s) <br />NOae <br />Total Fee <br />Signed Don Miller <br />Customer <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral_ <br />Abutting L�t Line <br />N, S, E, W <br />Ap�roved By H. $oushev <br />City Engineer <br />E. IIond <br />Issued Bv <br />InspectionBy (�''^' ' — <br />Date Inspected /.� � "�� __ <br />No. 23831 <br />�� <br />� <br />