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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 23524 DATE .3�%! Q� <br />Service Address � z � � �'"��""'" " <br />Billing Address <br />City, State, Zip.��-�'�.`-+ ��r�.D�v <br />Owner (Mortgagor �� <br />Billing N <br />Connection <br />� � � <br />'���' . <br />DESCRIPTION: <br />Lot < � <br />/ <br />Plat -�� <br />Unplatted Description <br />CHART N0. K 24-24-5 <br /><< <br />.� ED 7-24 �81 <br />Utility Account No. <br />o� —•= <br />Permit Fee <br />�U � <br />Connection Chargels) <br />✓ <br />Total Fee �d <br />Signed <br />Customer <br />SeH�r District <br />Mor thly Sewer Service. <br />Monshly Sewer GGnstr. <br />Ti unk <br />Lateral_ <br />Ab�t;mg �ot Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />INSPECT���N <br />Approved B'J�f ' ���'�"� - <br />Ciry Engineer <br />Issued BV <br />� .� / <br />I nspection <br />Date I <br />No. 23524 <br />