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everen <br />� <br />City of Everett <br />CHART N0. J /__%-��-,5" <br />%!�^.���. , <br />Sewer Application and Permit � <br />� <br />NO. 23OJrH DATE �__�7�, L <br />Service Address_��� a���� <br />Billing Address__.�(� � / � �7� <br />City, State, zin - . � <br />i.t _ � S � <br />Uwner (Mortgagor) � ° <br />� <br />Billing Name_� �j � <br />Cannection By '���. -- <br />Adciress <br />Phone <br />DESCRIPTION: <br />LOl /e i/ � � � <br />—� ��.� , Blnck—.3 / �' <br />Plat ��,.�� . � <br />Unplatted Descriotion <br />Utility Account <br />o✓ <br />Permit Fee �� �� <br />Connection Charge(s) <br />L � — <br />Total Fcc_ �� <br />Signed <br />---- — �� ��,.-i���,,: � <br />SEESKETCH ATTACHED <br />n��:,� �c,: � iuw <br />Sewer District <br />Monthly Sewer Scrvice <br />Monthly Sewer Constr. <br />Trunk_ <br />Abutting Lot Line �� <br />N, S, E, W_ %���� c�,._�% <br />_tt. <br />\PP��oe��il Bv <br />c��v -o��i��,,.;.� �-------- <br />:sued <br />�'/ �.�` <br />� � <br />ispection By��� �L Q � <br />ite Insperted c'�- j- 7c) <br />V -- <br />------ — <br />rvo. 23U5 �3 <br />