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CHART NC <br />evere" <br />�e <br />City of Everett <br />Sewer Application and Permit <br />NO. DATE — L---23282 <br />Service Address hi :5 —.?f — �� `�� Utility Account No. <br />Billing Address An --942 %% � —= Perr lit Fee 30 — <br />City, State, Zi <br />Owner (Mortgagrr)_ - <br />Billing Name <br />r <br />Connection By <br />f <br />Address_?�4� <br />Phon, - ' — k <br />DESCRIPTION: <br />Lot _�,�`� — Block / <br />Plat <br />Unplatted Description <br />Type Permit:', r <br />Remarks: <br />SEE SKETCH ATTACHED <br />Connection Charges) _ <br />Total Fee_ ` d <br />Signed •%;f L/ f� 1' - <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W__ <br />�J/ <br />Approved By-2 - <br />City Engineer <br />Issued By <br />Inspection <br />Date Inspected <br />NO. 23282 <br />F ,5JPE4 <br />