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ei <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22590 DATE <br />CHART NO-4V <br />z -Z3-2� <br />7" <br />Service Address C 3 �L; <br />Utility Account No. ------------ <br />Billing Address .d <br />Permit Fee 30�� <br />City, State, Zip <br />Connection Charge(s)_/Ud <br />Owner (Mortgagor)�s;/y/ /�i`/- r 30 Total Fee <br />Billing Name <br />Connection By <br />Address <br />Phone— 1 5 �i ,Q" 3 v, <br />DESCRIPTION: <br />Signed <br />Customer <br />Lot _Y9 BI k Sewer District_,3 <br />Plat. %/_ — Monthly Sewer Service <br />Unplatted Description <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk_ <br />Lateral <br />Abutting Lot Line <br />N, S, E. W <br />kpproved Bye <br />Gty Engoinew <br />slued By -- <br />; ;_ <br />rspection B e. <br />He Inspected <br />NO. <br />