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everen <br />e <br />City of Evarett <br />Sewer Application and Perr�nit <br />NO. 23864 DATE �"'�.�— <br />Service Address a s l '�4ti�tility Account No. <br />Billing Address Permit Fee ��� <br />City, State, Zip �� �9`�'' /���� �On�ection Chargels) P <br />/ � o _, <br />Owner (Mortgagor) = Total Fee <br />� <br />Billing Name <br />Connection By <br />Signed - „i .,, �-- � ,..,^` <br />Address c�s�om�. <br />Phone � S � — �� S� <br />DESCRI/PJTIO"N!�: <br />Lot � y_„� .o <br />Plat �,�� <br />Unplatted Descr <br />�� ' /.� <br />-s7 <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W. <br />/ <br />Approved By • - � <br />City •nyinett <br />Issued By � � <br />Inspection <br />Datelnspected <br />rvo. 23884 <br />