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i <br />`J <br />r <br />r <br />L <br />� <br />everetl <br />� <br />City of Everett <br />Sewer Application and Permit <br />NO. 24�37 DATE �a/y/� -� <br />Service Address_�� �� ^ " =-' � <br />Billing Address s'r/I � �-� � <br />City, State, Zip a=�0 ���- <br />Owner (Mortgagor) ` <br />8illing Name — <br />Connection By <br />DESCRIPTI ON: <br />Lo*. _— Block <br />Plat <br />Unplatted Description_ <br />HART N0. E -`' r3- -S <br />Utility Account No. <br />�� '�... <br />Permit Fez . <br />Gonnec[ion Charge(s) <br />/ 0=_ <br />Total Fee � <br />� ,,�:� <br />Signed � �', <br />� Cmtomer � � <br />$CWBf �ISifICi <br />Monthly Sewer Service. <br />Monthly Sewer Cons[r. <br />SEESKETCH ATTACHED <br />R45P[CTICN <br />La[eral <br />Abutting Lo[ Line <br />N,S,E,W. <br />Approved By <br />cur <br />Issued By " .— <br />i <br />�i ��� <br />Inspection ` ���- "' ���'�'�'"- ' <br />Date I nspected��' y� j ---� — <br />No. 2463T <br />�1 <br />I� <br />'1 <br />� <br />J <br />� J <br />