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W <br />City of Everett <br />Sewer Application and Permit <br />No. 23857 DATE <br />1806 Virginia <br />Service Address - <br />Billing Address -- <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By_ <br />City of E:eratt <br />Address — <br />Phone_ <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Tvne Permit: reoair <br />1/6/81 <br />CHART NO. 1 i� <br />Utility Account No._ <br />ncne <br />Permit Fee <br />Connection Charges) <br />Total Fee <br />none <br />Don Miller <br />Signed - <br />a�stoine. <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />trunk <br />Lateral <br />Remarks: n ,.c_., toeS. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W <br />H. Bouehey <br />Approved BY — <br />City Engineer <br />E. Bond <br />Issued BY — <br />Inspection By— , t /In is t � <br />Date Inspected /-1 - // <br />No. 23857 <br />