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, ;, _ <br /> CHART N0. <br /> Pveret� <br /> I G �w� � �— � • <br /> � e <br /> � �� � <br /> City of Everett �f'v WC>2 r <br /> ��7�.�'i0 �l,•�\ <br /> Sewer Application and Permit <br /> , <br /> No. 23359 DATE <br /> IService Address � I� e.L� P �i/= Utility Account No. _ � <br /> Billing Address� 9�_z1f �-,—S�S�LL_5� Permit Fee ,� D O <br /> City,State, Zip S.E/�7�L1� �/��� .r- Connection Charge(s) <br /> Owner (Mortgagor)�hK1�`��/-�TT_FSoN Total Fee 3� `D d <br /> Billing Name <br /> Connecticn By <br /> Address ' � � - Signed I <br /> _ -. ... . �_. ' . Custnmer <br /> I Phone � � � �� okj< ad<- <br /> 3z-� <br /> DE��R�T10N_3� Sewer District � <br /> Lat�' T—'S Block $3�� 3�' �onthly Sewer Service <br /> IPI3t_E- ✓_�'j�-jT 1�7 !/ �H'� <br /> Unplatted Description Monthly Sewer Constr. <br /> � Type Permit: Trunk <br /> i <br /> Lateral ! <br /> Rem3rks: � <br /> — Ab�tting Lot Line I <br /> N, S, E, W fL i <br /> i <br /> Approved By �� � �� <br /> City Engincet <br /> Issued By �- ' ' � <br /> _� <br /> � <br /> — , <br /> Inspection By <br /> D�te Inspected I <br /> SEE SKE fCH ATTACHE No� 23359 I <br /> i <br /> ' INSPECTION � <br />