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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23583 <br />DATE �� <br />� : -� . . c_. _ <br />Service Address ` ' <br />Billing Address � � � '� � � ` �' <br />City. State, �2ip ��- ':—� l�7 r!�_ <br />).. ' (_.� (. <br />(� .\ _ �_ < ' <br />pw�er (Mortgagor) <br />I��' �-' <br />Billing Name <br />�J ,j. : � : �, <br />Connection By ' <br />Address } `-' � - �' ` <br />,, r <br />phone <br />OESCRIPTION: <br />Lot�� <br />Plat i- . L_i . c... <br />Unplatted Descripti <br />Block `� � <br />C-, , ,. f _� <br />Utility Account No. <br />Permit Fee <br />Connection Chargel <br />Total Fee <br />/. '�.� /'; _.'-�.� �'�-f , <br />u � �_Signed ' � Customer ' <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKE7CH ATTACHED <br />INSPECTION <br />Lateral <br />�butting Lot Line <br />N, S, E, W <br />4pproved By ( I i � !: ' !, � C__: '-.; <br />City Enginecr <br />Issued <br />I nspectio n <br />lr . _ l . (.. L. � . ! : 1 (�_-% <br />Date Inspected <br />No. 23583 <br />