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everett <br />e <br />Ci.y of Everett <br />Sev�er Application and Permit <br />No. 24015 <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />pwner (Mortgagor) <br />DATE <br />3332 Na�san <br />6neie� <br />CHART N0. E' 30 -2q -S — <br />Utility Account No..— <br />none <br />Permit Fee <br />Connection Chargels) <br />none <br />Total Fee <br />Billing Name <br />Connection By Cit of. Everett Don Millez <br />SiqllCd Customer <br />Address <br />Phone ---- <br />Sewer Uistrict <br />DESCRIPTION: <br />Lot �--- Block_ Monthly Sewer Service <br />Plat _---------- Monthly Sewer Constr. <br />Unpfatted Description T M <br />SEE SKETCH ATTACHED <br />INSPECTION <br />�ut[ing Lot Line <br />N g, E, W <br />t <br />A. R. Theal <br />pproved BY �.�� E�9;,,��, <br />g, Dond <br />�sued BY----- <br />nspection By -� : L� ,� 7/.�-� • ,, � _ <br />)ate Inspected <br />�� ii-�'/ <br />No. 24015 <br />� - , <br />