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D <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0, 21835 DATE <br />Service Address;v LLB/ L(i�ix.ir^i< (- <br />Billing Address7a r C <br />City, State, Zip E— 0 1 `1 b ZO <br />Owner (Mortgagor) G:1 C • hjRYbOtiJ <br />Billing Name <-�N . Ot <br />Connection By ; -r '111 5-5= tVL-7zb21- <br />Pho <br />DESCRIPTION: <br />Lot I I kr' Block <br />Piat 1=-OF-276YT- <br />Unplatted Description <br />CHART NO. N saw <br />J�o,r3OF-;- 'e" D <br />Utility Account No. <br />I <br />Permit Fee <br />/,--I r-- <br />Connection Charge( <br />Total Fee t-'t C <br />Signed C �< `- ` (,z �.i\tlF -, <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk__ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By I __ k)L--'""" <br />City Engineer <br />Issued By -. r.. , i , „✓ <br />Inspection By <br />Date Inspected `z T <br />