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CHART <br />, evereft <br />e <br />City uf Everett <br />r <br />Sewer Application and Permit <br />� r.=�.:�.i �:,-, _= �:<=� <br />N0. 24401, DATE 11/15/9) i� z��-��.� <br />Service Address 1919 Stete Stre�t Utiiity Account No <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) — <br />Billing Name <br />Connection By City of E�erett <br />DESCRIPTION: <br />Lut Block <br />Plat <br />Unplatted Description — <br />Type Permit: Ret,air <br />Remarks: <br />f�,�f,�1��0 ��..� y' s . � . t <br />. ,� „ nr-.�� G�����' ,�-� , <br />� SEE SKETCH ATTACHED <br />Permit Fee t�one <br />Connection Charge(sl <br />Total Fee Nona <br />Don Miller <br />Cusmmcr <br />Sewer Distnct <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By A. R. Theal <br />CiIV Enginecr <br />Iss�ed By E. Bond <br />Inspection By <br />i <br />Datelnspected ' ' � <br />No. 24401 <br />INSPECTION i <br />� <br />J <br />