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/Vc i e N G t ✓3.L T .S'- i o- 7� <br />everett <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22304 DATE all �/� E, <br />Service Address <br />Y �i % 02lJi; d L'C <br />L <br />Billing Address' 74r// J/ <br />City, State, Zip <br />Owner (Mortgaaggo%%r)' "r/t <br />BillingNameT�itiC <br />Connection By L <br />Address /S S. <br />L4 747/-i -::5o7- <br />Phone - -' <br />DESCRIPTION <br />Lot Block / <br />Plat <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />"2js70�krd <br />6 zo -7'9 <br />Utility Account No. —lee - y /C�-r <br />Permit Fee -er U <br />Connection Charge(s) <br />-5 50. LOrd a, <br />-C.DU <br />Total Fee ✓ <br />Signed Yv F Ji .•"/ / <br />Customer <br />INSPECTION <br />Sewer District /G' <br />�•!�(' <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk /• <br />'� <br />Lateral ✓� ' (/ <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By - <br />City Engineer <br />Issued By � � G L /f' //A / <br />Inspection By--Z2 /�1 <br />Date I nspected <br />No. 22304 <br />