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everett <br />e <br />City of Everett <br />e <br />Sewer Application and Permit <br />NO. 23612 DATE 5/30/RO <br />Service Address 2919 Grm3 Atrenue <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By City of L•Verett <br />�.. <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: repair <br />'t <br />,. <br />CHART NO.� I�i G�f 'S <br />�aS�cE� 6- ►a-�o <br />Utility Account No._ <br />Permit Fee noae <br />Connection Charge�s�_ <br />none <br />Total Fee <br />�� <br />Doa l�till�r <br />Signed <br />Cuslomer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service. <br />Monthiy Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Ii. Wazren <br />Approved By _ <br />Ciry f3ngincer <br />E. }3ond <br />Issued By <br />Inspection By -� � �� ����� � � � � �'` <br />Date Inspectedli ' -+�- r%� <br />No. 23612 <br />