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everett <br />e <br />City of Everett <br />Sewer Application cnd Permit <br />rvo. 24614 <br />DATE �/�S/�3 <br />� �Service Address � �✓�9 �--1,/ �� <br />Billing Address 3 3�q %'�..1�Cd�({� <br />Ciry, State, Zip�` ' C ��Gl <br />� r <br />Owner (Mortgagor) <br />Billing Name -►� ° <br />Connection <br />Phone �`�� ` � 7'3� <br />CHART N0. � � ' � ` <br />Utility Accou�t No <br />Permit <br />Connection Charge�s) <br />60 _ <br />Total Fee %O _ <br />;' ' - <br />Signed <br />Cusmmer <br />DESCRIPTION: Sewer District <br />�ot /S—/6 e�a��j.�_.2�� <br />Plat �.-�.�� tY�� -� Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By`'.t ' -/� ' G7�T-�rL� <br />Ciry Engincer <br />Issued By �%/ • C `�� <br />Inspection By����'6�'�mon <br />Date Inspected g' ��' �3 <br />rvo. 24614 <br />� <br />_1 <br />