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everen <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23559 <br />DATE �/.3/ /SD <br />Service Address�y�� ��C�"T-� ' <br />BillingAddress JQ �- � �}� � <br />City, State, Zip ��, ��a- �o� � <br />Owner (Mortgagor�,,�%/1 Q �LL�� � � <br />Utility Account No. <br />Si_ <br />Permit <br />Connection Charge�s) <br />n •��-- <br />Total Fee � —. <br />Billing Name <br />�J� /� <br />ConnectionBy �12.T�^_^'���f"'-� �C2� <br />Phone A-��9- 6/ �� <br />DESCRIPTION: <br />Lot -��_ Block � 4 � <br />Plat � <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />Signed_ <br />Coslomcr <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved Byti9` " L�Lt/S/��"'�"' <br />Ciry Engineer <br />i� <br />f, ��o�� <br />Issued By �- <br />