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CHART NO. <br /> everett - <br /> e <br /> City of Everett <br /> Sewer Application and Permit <br /> �G, � <br /> NO. 25267 DATE �/0/1l �� (,j <br /> Service Address a �tility Account No. <br /> o�— <br /> Billing Address � � Permit Fee �D <br /> n H '~+1 <br /> City,State, Zip 6 ZD Connection Chargels) c�'n � <br /> U �Owner (Mortgagor � Total Fee /� �- <br /> Billing Name � � <br /> Connection By � Z <br /> Address Signed_ � � <br /> cus,omer N <br /> Phone- ���- 77 �s � <br /> DESCRIPTION: Sewer District � <br /> Lot �- Block� �' <br /> ^ .�.,p n .� �i Monthly Sewer Service y <br /> Plat c-�/�T.A LYli� �i— � � <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk . � <br /> Lateral � <br /> Remarks: <br /> Abutting Lot Line ,.� <br /> N, S, E, W ft. y <br /> � <br /> � <br /> Approved By ' <br /> Ciry Engineer <br /> —� ISSUOd By � <br /> I <br /> Inspection B�� L-��rbc'�r�ar� I <br /> Date Inspecter� �0 -�r- 8� <br /> SEE SKETCH ATTACHED N0. 252s7 i <br /> _ INSP[CTION <br />