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, <br />everett <br />I � <br />City of Everett <br />Sewer Application anc� Permit <br />� No� 23053 <br />DATE _ <br />� Service Address Q��+ � �-�.���' <br />i <br />i RillingAddress i // � <br />� City, State, Zip i�� i�. . �� <br />� <br />� Owner (Mortgagor) <br />i <br />Billing Name _— <br />; Connection By _ _ -� <br />� Address ____ <br />' P�lOfl@ ' : '� <br />DESCRIPTION: <br />Lot _ � lock � <br />I Plat—lEGE��---�CrI��'�---'�if'� <br />� Unp�atted Descri tion <br />'� T....o D......... - � ` <br />CHART NO. E�� ZU� S <br />� 6� <br />?�S(7�1 <br />� <br />U[ility Accoun[ No. ___ __ <br />Permit Fce <br />Connection Charge�s) + <br />Total Fee �� <br />% <br />, <br />Signed 'l,/ . /; — <br />CuSiOmCr <br />SEE SKETCH ATTACHED <br />INSP�CTOIJ <br />Sewer District �v <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk � ` <br />Late� �'. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By i;' <br />Ciry Enginecr <br />ISSUCC� BV '- <br />Inspection E3�"u'✓>'1 ✓Vayu-� <br />�atelnspected_ ' c S ' <br />N�. 23o5s <br />c� <br />�� <br />