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evereft <br />� <br />City of Everett <br />Sewer Application and Permit , <br />No. 23507 <br />ServiceAddress "`5 ti ■ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />DATE Z/21/EO <br />Connection By r�r s�.. t� — <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Block <br />CHART NO. V 2 g Z�1 �s <br />�s�� <br />,3 -zs.- �a <br />�� <br />Utility Accourrt No. <br />Permit Fee ..�*+� <br />Connection Charge( <br />Total Fee_ non <br />Signed Don Miller _ <br />CuTtomcr <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Cons[r. <br />Trunk <br />SEE SKETCH ATTACHED <br />'di,l'c(.1 ILId <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By '.'• Warrnn <br />Crty Eng�nccr <br />Issued By :'. '�unci _ <br />/. �� <br />Inspection By–� '��- :"" � — <br />Date I nspected % " Z �� ��) , <br />No. 23507 <br />