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everett <br />� <br />City oi Everett <br />Sew�r Aipplication and Permit <br />No. 23232 <br />Service Address <br />Billing Address <br />Ciry, State, Zip � <br />Owner (Mortgagor) <br />� <br />Billing Name .' <br />Connection By . <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Plat <br />Unplatted Descr <br />Tvpe Permit: <br />Remarks: <br />I CHART NO. � �- � � ' ' <br />D.QTE I_ <br />Utility Account No._. ____ <br />_ Permit Fee <br />� Connection Charge�s) <br />; . __.___ <br />Tot.d Fee <br />Block �' j� <br />Siyncil <br />�� <br />�Er�oJEO A4�7 Cor.;cti[T� f /t'�P .�c�l' <br />�..li �H G� � ny7 i�oN �n�S nr Q�l�f,� � <br />SEESKETCH ATTACHED <br />c�, .�, —� — <br />Sewer Disvict <br />Monthly Sewer Svrvice _ ___ <br />Monthly Sewer ConsU. <br />Trunk_ ___ <br />Lateral <br />Ahutting Lot Line <br />N, S, E, W it. <br />'���proacd f31'---- —. --- <br />CiIV Brymem <br />� SSU ef� <br />i� <br />Inspection By � c. . � __ _ _ __ <br />q 'i.i'C'\� <br />Date Inspected _____ __ <br />���:. 23�32 <br />