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CHART NO. <br /> everett <br /> e <br /> City of Everett <br /> Sevv�r A�plicction and Permit <br /> DAT� I I� Ci �d'.7 � <br /> No. 250;16 h <br /> Service Address <br /> �� P,� .5�� Utifity Account No. 7�0 � �� � <br /> BillingAddress_�LO`�.1i S� � V2fE� g�� PermitFee �' � G <br /> (� v.t �,V,�� ���0 � Connection Charge(s) '3 "� <br /> City, State, Zip_1 ~' "jy <br /> �/ Total Fee__ � � G� ¢ t7 <br /> pwner (Mortgagor) /j� �I/ -� ��b m�S ,� <br /> Billing Name �/�m P � � <br /> Connection By ��m e" . / t� <br /> �;: � H <br /> �� ,_ z <br /> Address G Signed � <br /> �c�(stoncr <br /> Phone �.J✓� — yy /� �p�v� � � N <br /> DESCRIPTION: Sewer District_ ' � � <br /> Lot � o� a. Biock — Monthly Sewer Se�vice --- [� r� <br /> U�rn �P.v2 ���_ �n <br /> Plat I <br /> Unplatted Description Monthly Sewer C.onstr. <br /> o77D - = I `� <br /> Trur�c I � <br /> Type Permit: � v ekl � G^'�y QC j/��J' Lateral I <br /> I <br /> Remarks: Abutting Lot Line I � <br /> N, S, E, W _ ft. <br /> � � <br /> � � <br /> I � <br /> I ~ <br /> 7heaL_ � <br /> Approved By � � � <br /> City Enginrer <br /> Issued By — <br /> — „ _(1� � <br /> �i��i�yiii�� <br /> Inspection By�— <br /> Datelnspected 3—� ����—�-- I' <br /> SEESKETCH ATTACHED <br /> No. 25016 � <br /> INSPECTION I <br />