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everett <br />e. <br />City of Everett <br />Sewer Application and Permit <br />No. 23399 <br />DATE 11/::/') <br />Service Address 2110 Rainier <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By City of F_verett <br />,I,; <br />DESCRIPTION: <br />Lot Block <br />Plat — <br />Unplatted Descripti <br />Type Permit: <br />Remarks: <br />AZ' 42,le <br />SEE SKETCH ATTACHED <br />CHART NO. F20 -Z 9—S <br />Utility Account No. <br />Ps/-257o <br />/z-2 2,,F <br />M <br />Permit Fee none <br />Connection Charge(s) <br />Total Feenone_ _ <br />Don Miller <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />I/ <br />H. Warren <br />Approved By <br />City Engineer <br />E. Bond <br />Issued <br />Inspection BY4'* <br />Date Inspected7�7 _ <br />No. 23399 <br />INSPECTION <br />