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everett <br />� <br />City of Everett <br />Sewer Appiication and Permit <br />No. 22843 DATE ! <br />Service Address = � 7_ ����_-�-�� /� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />�.,.,_,.__ ' , <br />I Phone <br />DESCRIPTION: <br />Lot _ Block — <br />I Plat <br />� Unplatted Description <br />Type Permit: <br />CHART NO:�� �`2'a_"✓' <br />�z�-z�-s <br />�y�� . <br />1 �� ' <br />� '2"�� <br />Utility Account No. <br />Permit Fee <br />Connection Chargel <br />0 <br />Total Fee <br />Signed <br />nemarrcs: � ,� � y�� ,,. �� �� <br />,2!/. � if/. ,*/ //f i�-�:.... -1liK— --- <br />SEESKETCH ATTACHED <br />ItJSPLCTIC�I; <br />..r _. . . _ _ <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Lateral <br />Abutting l.ot Line <br />N, S, Es _W <br />Approved By <br />Ciry Engineer i <br />ISSUed By �� � <br />I <br />Inspection By = � (�. � � 7 %n t . � �' /T <br />Datelnspected / ' y � - ��1 � <br />No. 2?843 ', <br />