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everett <br />.e. <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22521 DATE ' S /7, <br />Service Address <br />Billing AddressX <br />City, State, Zip,,' - I-, ,... �44ota 1 Uo <br />Owner (Mortgagor)'�'42,1-:"1 <br />Billing Name__ ry t r <br />n <br />CHART NOA/27= " <br />Utility Account No. �' - t`� <br />-i <br />Permit Fee <br />Connection Charge(s) -2� ! Y� <br />Total Fee_ 3 r' <br />Connection By L- <br />/ AddressL y i 1. G i 7i .G- Signed--� <br />Customer <br />Phone — <br />DESCRIPTION: Sewer District. <br />Lot Block <br />Monthly Sewr r Service <br />Plat 1t/%T�a•L i-�+ <br />Unplatted Description.. -'r : ,J <br />Type Permit: / xb-_ / I / C! A/X A <br />Remarks: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Monthly Sevi er Constr. <br />Tr ink <br />Abutting Lot Line — <br />N S E; W <br />r <br />Approved By ��< A <br />City Engineer <br />Issued By. C . `-%' � L-! x <br />InspectionC;!� <br />Date Inspected <br />NO. 22521 <br />