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everett <br />e- <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22419 DATE 4/S/7 <br />ServiceAdd <br />Billing Address <br />City, State, Zip Es.--' ! '' <br />owner (Mortgagor) <br />Billing Name 'w <br />Connection By <br />Address_ <br />Phone '� r -Z _x9� % <br />DESCRIPTION: <br />SEE SKETCH ATTACHED <br />CHART NO. / ' CL S' <br />i3 <br />Utility Account No. <br />Permit Fee _-LSD <br />Connection Charge(s) <br />d <br />Total Fee 36F <br />Sign'ta ' ! eLt'7(� <br />Cusmmer <br />INSPECTION <br />Sewer District,f�(u <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Latera <br />Abutting Lot Line - / ' <br />N, S, E, W 74- •/ ft. <br />Approved BY % <br />City Engineer <br />Issued By. <br />Inspection B / D <br />Date Inspected <br />NO. 1- -1. <br />