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cvcrcU <br />� <br />City of Evcrett <br />� <br />f <br />��v�e� Applocatian and Permit <br />CHART NO.__ _ <br />��'�S� �� <br />�� Z4 �7� <br />I �� <br />7 <br />No. 23017 DATE __ ----- — -- � <br />�`= , , <br />Service Address "– – J� �Ce.c.�, f%Utility Account No. <br />-� / <br />E3illing.4ddress '` � � ' Permit Fee <br />City, State, ZiP— Connection Charge� <br />Owner (Mortgagor) Total Fee <br />[3illing Name <br />Connection Bv <br />� Phone <br />, DESCRIPTION: <br />I <br />Lot <br />Plat <br />� Unplatted Descr <br />iType Permit: <br />Remarks: <br />, /. <br />Customer <br />Sewer Districl <br />Block <br />Monthly Sewei Service <br />Monthiy Sewer Constr. <br />(' /' y ' /� / -' <br />' , _ i .., u <br />S[E SKETCH P�TTI�C!I[D <br />AbU[ting Lot Line <br />_.�" N, S, E, W <br />Approved By <br />Crty Enymeer <br />!s5�,�d av_-- - , <br />� <br />i���,,���:�����, 3� -- _ ---� <br />�Date Inspected___ - % % _ <br />°��> 23017 <br />