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evere[t <br />e <br />City of Everett <br />Sewer Application and Permit <br />rvo. 24298 <br />Service <br />Billing <br />City, S <br />Owner <br />Billing <br />Connec <br />DATE _h(_�S��P iZ. <br />DES�CrR�IPTION: <br />Lot,[_/-�� %� BIocK <br />Plat - ��w,f.� �,� .3 Z� <br />Unplatted Description <br />CHART NO. <br />�os,-�� <br />,_ l_ �Z� <br />Utility Account No. <br />ia <br />Permit Fee_�rD �!� <br />Connection Charge(s) <br />Total Fee �0 �r <br />Signed ,,c:"v.. : . -. . - . <br />Customer <br />SEESKETCH ATTACHED <br />INSP[CTION <br />Sewer D <br />h"enthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By�. �� �� <br />Ciry Engincer <br />Issued By_ ���� � <br />Inspectio� By� � <br />late Inspected �� S o� <br />No. 24298 <br />J <br />