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everetf <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22486 DATE <br />Service Address J� i� �"` z'2"' r= <br />BillingAddress <br />City, State, Zip" <br />Owner (Mortgagor) <br />Billing Name ��y' i.—• --// �-^r- <br />i� ' < <br />Connection By <br />Address " <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description's _ <br />Tvnp Pprmif- <br />Kemal Ks: <br />a <br />CHART N0.! <br />1ptosTdCP-� <br />S-zl-?8 <br />Utility Account No. <br />U// <br />Permit <br />Connection Charge(s) <br />Od <br />Total Fee_ d -- <br />e- <br />Signed_ <br />Customer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />T;,ty Engineer <br />Issued By r_rT= <br />t. <br />Inspection By <br />Date Inspected <br />SEE SKETCH ATTACHED NO. <br />