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eXerett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22544 DATE ' /- Z - -"7 f <br />CHART NO.1636-;&:,� <br />Service Address Utility Account No. <br />Billing Address '"'��� �04'G Permit Fee <br />City, State, Zip 0 3 Connection Charge(s) <br />Owner (Mortgagor) =w V /Total Fee — <br />Filling <br />Connection <br />Address <br />Phone — <br />2 -2 � - e7s <br />Signed �'wto"r <br />DESCRIPTION: Sewer District <br />Lot Bloqk Monthly Sewer Service—..-' <br />Plat <br />Unplatted Description— Monthly Sewer Constr. <br />SEE SKETCH ATTACHE[; <br />INSPECTION <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S. E, W, <br />Approved B <br />City Engineer <br />Issued By <br />B <br />Date Inspected _Y_ <br />No. 22544 <br />