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0 <br />, everett <br />� � <br />� City of Everett <br />� Sewpr Application and Permit <br />� No. 23052 DATE ' ! f <br />Service Address_ r�'%/�_� �,/ir-e� �, <br />� Billing Address � i � <br />I City, State, Zip i � <br />I <br />Owner �Mortgagor) i _ <br />I <br />i Billing Name -- <br />� Connection Bv - -- <br />CHART NO. p I -Zp -S <br />- C� - i ?r-= k-� <br />�� <br />��s��� <br />F`' <br />Utility Account No. <br />Permit Fee <br />Connection Charge� <br />'otal Fee <br />-•-1 _ <br />.' � <br />Signed � `• 1. <br />" ' Customcr <br />f'Ihone � i � / <br />DESCRIPTION: Sewer District <br />Lot �lock <br />Plat ��.-,.,� ��x�,.-� �� Monthly Sewer Service <br />Unplatted DescripYon Monthly Sewer Constr. <br />Type Permit: � "-' Trunk <br />i <br />Lateral <br />SEESKETCH ATTACNED <br />�N`PFCTION <br />Abutting Lot Line <br />N,S,E,W <br />Approved <br />City Engmeer <br />Issued By <br />Inspection By �'� ��� � `�� � <br />Date Inspected � - �S <br />No. 23052 <br />� <br />