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ev�rett <br />e�� <br />City of Everett <br />(X_ 9 I��{ 1'� 9 I CHART NO. �- 3� �� `{ <br />Sewer �pplication and Permit <br />No. 23023 <br />DATE �-��-%� <br />� <br />Service Address�,� =�. �,zc-,z �c..�. _ <br />��� <br />Biliing Address 3� / � /i /_ ��� ���t'i�c<_ <br />City, State, Zip �..�e� fG'� ��r0 ri <br />Owner (Mortgagor) !�� �c � �i-��� i � , <br />Billing Name �`_..-,.,- �— _ <br />Connection By /%�+-�+-�'--- _ <br />Address <br />Phone <br />-509� <br />DESCRIPTION: <br />Lot � - BlocJt��; <br />Piat �,�•� Gr �2Ff.ci <br />Unplatted Description <br />�os�� <br />//-/Z-7 f <br />��� <br />Utility .4ccount No. _ % � �� /' <br />Permit Fee <br />�O p! <br />^v _ <br />Connection Charge�s) �/� <br />� <br />Total Fee_ � 4 n <br />Signed <br />cu:�omcr <br />SEESKETCH ATTACHED <br />IIl51'E�TION <br />Sewer District �� ��,.� � <br />Monthly Sewer <br />Monthly Sewer Co�str. <br />Trunk /. /� <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />�� O <br />>G �� ' <br />Appraved By�� it,c� -�u-�� <br />City Enginecr <br />C' /J J <br />Issued By � - C ��� <br />Inspection By ✓ � <br />Date Inspected 0 � �R _ � <br />N�. 23023 <br />