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everen <br />e <br />City of Everett <br />Enyinaering & Community Services <br />Sewer Application and Permit <br />CHART <br />No. 21976 DATE �f��'�''"l7 � <br />Service Address Z��-�C� i��-{�.11-f�.�'� Utility Account No. <br />BillingAddress_ 5��+�� PermitFee ��C+�7�= _ <br />City, State, Zip�-V''=T��"'T- ��� � <br />Owner (MortgagorlT/�c.i(_ C��C <br />Billi:tig Name �~��E" <br />Connection By �t'rtf � Ce� � �ft�-f� <br />Address <br />DESCRIPTION: � , ,.� <br />Lot 3i -3'L glock t� <br />Plat '�-'�T_ lL��l�� <br />Unpiatted Description <br />Connection Charge(s) <br />Totai Fee i�G`A�+�--= <br />Signed �C�1L- T�Q-,OS`3�f.�-yQ-- <br />c�:co�K. <br />SEE SKETCH ATTACHED <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />h, S, E, W. <br />Approved By � ` ��--'N � l� <br />Ciry Enqineer <br />Issued By � . �nC.-�,•J tJ �sc.� <br />Inspec[ion <br />Date <br />CUSTOMER COPY <br />No. 21g76 <br />