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� everett <br />�e <br />ICity of Everett <br />Sewer Application and Permit <br />NO. 2QQ65 DATE _— <br />Sti2G South 2nd Avenue <br />Service Address — <br />Billing Address <br />Ciiy, State, Zip — <br />Owner (Mortgagor)__ _ <br />Biiling Name <br />City of Everett <br />Connection By — <br />Address — <br />DESCP,IPTION: <br />Lot <br />Plat -- <br />i Unplatted �escr <br />� Type Permit: <br />Remarks: <br />Blnck <br />TJew Connection <br />� <br />SePtewLer 3, 1981 <br />�� G� � /�V.k� .;'. �' �'y'�/1...� .�--� <br />/ � i/,..,i i h �-� :% . <br />I <br />�— <br />SEESKETCH ATTACHED <br />CHART N0. <br />Utility Account No._ <br />Permit Fee *+one <br />Connection Chargelsl— <br />nono <br />Total Fee <br />DON HILLF.A <br />Signed <br />Cusmmer <br />It:�,�.��lit i��:�.�� <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />A. F. Theal <br />Approved By_ <br />C+ry Fngineer <br />�, n�nd <br />Issued By — <br />Inspection By '��'"'� •^ �1�•.;..,� �.,.1 <br />Date Inspected `�' 3 - �i <br />No. 24065 <br />t. <br />