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CHART NO. <br /> everett <br /> e <br /> City of Everett <br /> Sewe� App�icction and Permit <br /> N0. 25�7� DATE _�_,�} }6, }gB5 �,�, <br /> Service Address_Jy�s �y� its��p Utility Account No. � <br /> Billing Address '130i - i�i 6Lfwt Permit Fee � i0 <br /> City,State, Zip ,y��q���h � f02pp Connection Charge;s) 3 '~*� <br /> � �Owner (Mortgagor) y�� ��r _ Total Fee_�� i0 <br /> Billing Name c.�. � <br /> � <br /> Connection By s� � <br /> Address � - KK]] ~ <br /> Signed_ � , % ��!! z <br /> Cusromer � � <br /> Phone iio-�il9 � y '" <br /> y <br /> DESCRIPTION: Sewer District �j � <br /> Lot�_ Block—�_ <br /> Plat�ti.+w� r��„� . Monthly Sewer Service � N <br /> ro . � « ��.. <br /> Unplatted Description Monthly Sewer Constr. � <br /> Trunk • � <br /> Type Permit: Gp oif <br /> Lateral <br /> Remarks: � <br /> Abutting Lot Line <br /> N, S, E, W ft. � <br /> M <br /> N <br /> N <br /> _���` Approved By , � <br /> �ro� 1.ASi�G�o.�i icv npineer <br /> c�'ze�e /G.�,.w� Issued Ry_ �an�r Csawi-- <br /> �/6 _d. Inspection By <br /> Datelnspected <br /> SEE SKETCH ATTACHED NO. 25076 <br /> INSPECTION I <br />