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CHART NO. i 13 2f3-y <br />QvereQt <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23562 DATE T <br />Service Address.? D Z. <br />Billing Address <br />City, State, <br />Owner (Moi <br />Billing Nam <br />Connection <br />V <br />Phone :1";— 1 - & '7 / <br />DESCRIPTION: 17 <br />Lot <br />Plat ck <br />Plat � �—• <br />Unplatted Description_ <br />Tvnp Pprmit- <br />SEE SKETCH ATTACHED <br />Utility Account No. 73-6 2 2-- <br />Permit Fee D a' <br />Connection Charge(s) <br />7 BJ <br />Total Fee _> <br />Sewer District 130,✓o i L <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk --zi Z"S— <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Eingineff <br />Issued By ~ <br />Inspection <br />Date Inspected 1K I dr—O <br />No. 23562 <br />INSPECTION <br />