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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />N0. 24213 �-�/� DATE � �� — � � <br />Service Addres ,. <br />/` <br />BillingAddress ��/� ����o. �� <br />City, State, Zip <br />Owner <br />Billing Na <br />Connection 8y <br />Address z Z y$7l �V�-. <br />Phon ^ �� <br />� <br />Plat _� <br />Unplatted <br />e <br />CHART NO. � � = U -:' � <br />''r =�� �/f!�'�� , <br />Utility Account No._ ��v �,.� 7— 0 � <br />Permit Fee <br />3 p �' � <br />�- <br />Connection Charge�s�_ �a O <br />op � <br />l'otal Fee '' <br />� � "".e'E �c�.� - f� � <br />Signed <br />cu:ton�er <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District /����0� <br />Monthly Sewer Service__ � •s� <br />Monthly Sewer Constr. <br />Trunk 6a_ ,� � �%O � <br />Lateral_� • �.� /.S—p' � <br />Abutting Lot Li <br />N, S, E� 026 ft. <br />Approved By_ �� � / <br />Gry Engmcer <br />Issued By i <br />Inspec <br />Date I <br />No. 242i3 i <br />% <br />