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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23885 <br />Service <br />Billing Address <br />DATE x/6/el <br />1715 Raiaiwr 1►�enue <br />CHART NO. %� ��"Zq's <br />Utility Account No._ <br />Permit Fee <br />aoa• <br />City, State, Zip Connection Charge(s) <br />Owner (Mortgagor�_ Total Fee <br />aon� <br />Billing Na <br />Connection By_ �� ty of 8�arstt <br />Don Millaz <br />Address_ Signed <br />Customer <br />DESCRIPTiON: Sewer District <br />Lot Block Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />butting Lot Line <br />N, S, E, W <br />�-�,� <br />A. Bouehey <br />pproved B•% <br />Ciry Engineer <br />S. Hoad <br />sued By <br />> <br />ispection By �' r r� %J/ ic - -: , ,� � <br />Date l nspected - � - r � <br />No. 23865 <br />