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CHART NO. <br />� everett <br />� e <br /> City of Everett <br /> Sew�r ApPlication and Permit <br /> `�S� � <br /> N0. G5146 DATE ___-�/ /' �� � <br /> ��C,� �,�yAl� /-,'1/� Utility Account No. <br /> Service Address �� - : � <br /> � Permit Fee <br /> Billing Address 1 1 , y .'-',� <br /> , - - j 1 ^�, / % ' Conncetion Chargels) <br /> i �' � <br /> City,State, Zip - -� � � i � <br /> � � � � � � Totai Fee �--��— � � <br /> pwner (Mortgagor� I � <br /> Billing Name �✓e����V ���� � <br /> �� � <br /> Connection BY ' ~ <br /> : � z <br /> 1 ' — �I(]f1CC� Cusloner � <br /> Address �'— H <br /> � N <br /> Phone —"— — <br /> Sewer Di;trict i � � <br /> DESCRIPTIO : � <br /> Lot Block Monthly Sewer Service I � <br /> Plat � � _Monthly Sewer Constc I � <br /> Unplatted Descripiion -- � N <br /> — Trunk � <br /> Type Permit: ��G ���� Lateral I <br /> �:np �G�[�i.�i+ {fOL.'S��- � <br /> ����~' Abutting Lot Line {t I �. <br /> Fiemarks: <br /> N, S, E, W Hy <br /> H <br /> y <br /> , �� � <br /> ,_ ` <br /> ApptDVCd By ����E�qinccr I <br /> � <br /> Issued SX / , I <br /> Inspection By <br /> "��RbP I.. ..� <br /> Date Inspected_ �' - ���� <br /> - No. 25146 <br /> SEE SKETCli ATTACHED <br /> INSPECTION ! <br />