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everett <br />e <br />City of Everett <br />Sewer Applic�ation and Permit <br />NO. 236%2 DATE <br />Service Address �. i �, � , � <br />�_ <br />BillingAddress � : ��,/ '�/ �� � , <br />City, State, Zip �_ . _ , /( � <br />Owner (Mortgagor) ) � <br />Billiny Name � � � <br />Connection By ' � , , <br />Address �, � ./ ,. I, r_ <br />Phnnn . . , r . — <br />DESCRIPTION: <br />Loi _ � Black.__ <br />Plat , � <br />Unplatted Description___ <br />Type Permit: <br />_ , <br />CHART NO, v 32--2C� —S <br />! os;e..0 iJ-z3-�?1 <br />L :-- <br />Utility Account No._ <br />Permit Fee <br />Connection Charge(s) <br />Total Fee � - <br />Signed' <br />Customer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Co�str. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By � � <br />Enginee� <br />ssued By � � � � - . , <br />/.��� <br />�/--�� � � �/� �: <br />nspection By_1.� >� ���taC�iC� <br />> // <br />'ate Inspected � �r-�2 �—�U <br />rvo. 23672 <br />`t. <br />