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, <br />q <br />everett <br />i <br />�e <br />� <br />� City of Everett <br />Sewer Applicatiion ar�d Permit <br />No. 23054 DATE <br />Service Addresi g '�y .�� ,`✓,�. � �. <br />Billing Address <br />City, $tate, Zip <br />Owner (Mortga� <br />8illing Name_ <br />Connection Bv_ <br />Phone _ _ , — , <br />CHART N0. � %?'��+�'S <br />�e�xur <br />��s��� <br />p`_ <br />Utility Account No._ <br />Permit Fee_ , ' <br />Connection Charge�s) � <br />Total Fee_ <br />i- <br />�. <br />Signed _ i�' <br />c��:�o�� <br />DESCRIPTION: Sewer Dictrict i -"/ <br />Lot � Block <br />Plat 'f����,��%,i,_, �r ��� Monthly Sewer Service � <br />Unplatted Descri�t%n Monthly Sewer ConsV. <br />Type Permit: ,;: -' <br />SEESKETCH ATTACHED <br />,,;_ �� ri�;c; <br />Tru <br />Abuu ng Lot Line <br />N, S, E, W <br />Approved By <br />Gry Enginccr <br />Issucd By �" <br />In i "� �%1 ` '�ttL <br />spec[on By___t��r'"`� � <br />Date Inspected���J —7� <br />No. 23054 <br />'�- <br />