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H <br />everen <br />� <br />City of Everett <br />Engineering & Community :'�ervicas <br />Sew�er Appiication ar�d Permit <br />No. 22253 <br />DATE - � " / /,`/'', <br />Service Address � � % `-'`/' % 'l ' - - <br />Billing Address r� '' '' ' �` - <br />,� <br />City. State, Zip . ~� . L`;: - _� j <br />Owner (Mortgagor) • ��� --� <br />� <br />Connection <br />Phone ` `� � �= <br />Utility Account No. <br />��,�_.-- <br />Permit Fee �v <br />Connection Charge(s) l^—r� <br />_ -.;�..- <br />Total Fee � `j — <br />Signed `,�-.-� � ��`� <br />D[u�omx <br />/ <br />DESCRIPTION: Sewer District <br />Lot l� �� Block <br />• ' , Morthly Sewer Service ^� • >'U <br />Plat ' �- - <br />Unplatted Description % �` /-� �- � `� Monthly Sewer Constr. <br />T....n Dwrmit• � . . � � � � TfUt1IC • ' <br />a <br />; , <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line .-, . <br />N S F W /�; ft. <br />Approved By -'� <br />Ci�y EnOineer <br />Issued <br />I:ispection <br />Da[elnspected <br />No. 22253 <br />INSPECTION <br />