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everen <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 24661 <br />DATE /D��/�P � <br />Service Address <br />�d �/ '� �i___. � ��O Utility Account No.._._! � � �� � � <br />Permit Fee 3Q � <br />Billing Address - � a�- <br />City, State, Zip� ",-'�> y� " /���� Connection Charge(s) ��a <br />pwner (Mortgagor) <br />� Total Fee_ � � o% — <br />Billing Name_ �Ls�' " ^ �" " � l <br />Connection <br />Address � �S9 �D % d <br />Phone— — <br />DESCRIPTI <br />Lot � <br />Plat �/¢a <br />Unplatted C <br />_.- , -. , �: �: i' l ^� <br />SignOd Customer <br />Sewer District U �'� <br />Monthly Sewer Service 6 �� <br />Monthly Sewer Constr. ov <br />Trunk ���— <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N,S,E,W <br />qpproved By `�� ' %� �`� o� <br />Ciry Engincer <br />Issued By <br />Inspection By "' � <br />Dateinspected � �8� <br />No. 24661 <br />