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eve�ett , <br />� <br />City of Everett <br />1 <� _ S <br />CHART iVO. r �' � � � � <br />�n 5 y��= ��,l �• i'� /i G i; S' <br />.�"c• (/%y . <br />Sewer Application and Permit <br />No. 23352 DATE ' , <br />Service Address �? �1f t7 _S 2_ ni/� �-7— Utility Account No. <br />Billing Address�,�, /�°1� L J%U permit Fee_ �� '�% Ci <br />City, State, Zip1. DJ�(�OIVhS��Q<LO Connection Chargels) ' <br />Owner (Mortgagor) %'tDU/ N�n /�/����c__ �/� k Total Fee � O . d d <br />Billing Name� <br />Connection <br />Address- <br />Phone_ �% �_�" <br />., �.. <br />DESCRIPTION: <br />Lot�_ Block � _ <br />Plat L /� �AL�I�J l �� �� %, <br />Unplatted Description <br />Tvnn Parn.b• <br />Siyned <br />Cuslcma <br />SEESKETCH ATTACHED <br />IN;>I•l�.C1��UN <br />seW��oiscri�c I � /3o�✓a � <br />Monthly Sewer Service_ 3- O � <br />Monthly Sewer Constr. <br />Trunk / . / � <br />Lateral � • � J <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engmeer <br />Issued <br />Inspection By -�' %�' �� <br />� <br />)ate lnspected �l ��' � i� <br />rvo. 23352 <br />