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�C'VC�E'ii <br />� <br />City of Everett <br />Engineering & C��munity Servicas <br />Sewer Application and Permit <br />No. 22325 <br />DATE / / J�,�;�_ <br />Service Address`i �� � 0 = �f � ��- - l %.�-�_ <br />`^ �'�%� � � �:�.._. , �' <br />Billing Address � _7 .•� ';;c,. <br />,: <br />% <br />Ci: State, Zi � J'' A <br />Y. A--.': ( :.1;'�• <"C!r . % �I��� <br />. <br />. j <br />Owner (Mortgayor) ' � �;= .�:-_.�-_:. : J <br />Billing N <br />Connection Bv .�'`..-. . <br />5��_ ��/G <br />D�SCRIPTION: <br />�oc 1v- �: e�ock 3 <br />Plat r � % / ^' ,� �� <br />Unplatted Description <br />CHART NO. � �` '' �' <br />� ;�.� . . % - .. <br />s <br />Utility Account No. �"�6- �///- � O <br />O� <br />Permit Fee .! d "�- <br />n�� <br />Connection Cha�y=(s) � '•• �J <br />% <br />Totai Fee i �� <br />, /� <br />i (i ' <br />Signed � ' `- --- <br />customer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sev+er District �6 _ � ...�L <br />Monthly Sewer Service_ i U <br />Monthly Sewer Constr. <br />�J <br />Abutting Lot Line <br />N, S, E, W <br />- i/ <br />Approved By V !/ _ _ <br />Gty E�pmeer • � <br />Issued 8y � _ .•'��., � <br />nspecLon <br />)ate I <br />NO. L L � L � <br />