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everen <br />e <br />City of Everett <br />Sewer Anplication and Permit <br />N0. 2522� ��Net 46, 19Q5 <br />DATE <br />Service Address =�s �� �� � �iry <br />Billing Address p•o. eox 204 <br />City, State, Zip �Ywille, Ha. 98270 <br />Owner (Mortgagor) �id SR�tar <br />Billing Name <br />Connection By <br />D[:SCRIPTION: <br />Lot e Block �62 <br />Plat _.i,ssliR n1 r <br />Ilnplatted Description <br />Utility Account No.__ <br />Permit Fee �.50 <br />Connection Chargel5l. <br />Total Fee �.50 <br />! ' <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Mon;hly Sewer Constr. <br />Trunk <br />Lateral _ <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abirtting Lot Line <br />N, S, E, W <br />�.. R. Theal <br />Appieved By <br />Ciry Engineer <br />fi. Boi1d <br />Issued Bv <br />�� �,b�/,,,,,�... <br />Inspection Byd <br />Date Inspected y r-� <br />No. 25226 <br />