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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicafion and Permit <br />No. 22168 DATE Z- ,26- "M <br />Sprvirp Aririrpcc �IK— �_.-rs/ .-4:�' <br />Billing Address.-Q - ? .� 36 3 (j <br />Cit/,State,Zip ';'z"-i:. T_��i fdrjz� <br />J) L� , <br />Owner (Mortgagor) �//i��� <br />i <br />Billing Name.-�-- <br />Connection Byi - v <br />Address <br />Phone 3 5 - 1W1114 <br />DESCRIPTION <br />Lot. Block <br />Plat <br />Unplatted Describtion <br />Type Permit: Y j . <br />Remarks: <br />SEE SKETCH ATTACHED <br />CHART N <br />2.0 -7 <br />n Wst <br />Utility Account No. -3-1 %• ^? 77- 00 <br />Ste' <br />Permit Fee > O <br />Connection Charge(s) ^'16 <br />if I? <br />Total Fee- <br />Signed — <br />INSPECTION <br />Sewer <br />Month <br />Month <br />Abutti <br />Approi <br />Issued <br />Inspection By <br />Date Inspected/7Lp _ <br />No. M 1 <br />