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everett <br />� <br />City of Everett <br />Sewr�r �lpplicatian aa��! P�ernnit <br />CHART NO. � � <br />�� .S-Zf/ S- <br />��5'�E-D <br />.S"�8 "�% <br />�� <br />NO. ZG9��I DATE ^�7'��' _ l� <br />Service Address �_7 •'� �' 2T •? n r-+.E' G;a.�. `� �d t; Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Permit Fee <br />Connection Charge� <br />Total <br />Cnnnection By ,. �' . <br />i ` � ;../ <br />Address Signed � "', <br />, . .ca �omer . <br />Phone <br />DESCRIPTIG�ry, Sewer District � <br />Lot_ �^arx./ Block � <br />Plat - � ��o'�yi-t `2� Mon[hly Sewer Service _ <br />Unplatted Descriptio�r� Monthly Sewer Constr. <br />�..... _,,._ <br />Type Permit: <br />SEESKETCH ATTACHED <br />�'r1:=PPt ll�',� <br />i_ateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By__ <br />Engineer <br />Issued <br />Inspection By__`-c3�.�L'Y1 � � �. <br />/� q/ - � _�./ <br />Date Insuected �-1-� �u (D ' 7 J <br />No. 22995 <br />