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everetl <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23601 <br />Service Addre;s <br />Billing Address <br />City, State, Zip <br />Owner (Mortqa <br />DATE �/N/Y d <br />� - /� <br />Billing Name ���' �{-� l/_ �/- �L: /�-•� <br />� ,� <br />� . �� ~ /' /' <br />Connection By Ey�!-_.,:.� ��r. 1.���- <br />CHART NO. M ZI • Z9 -3 -_ <br />���� �-2�t'� <br />Utility Account No. <br />� 4� <br />Permit Fee <br />,/c� �'�— <br />Connection <br />Total <br />J �' <br />Address �`��'� _"-`f�� %f E�' y,2 i,, Signed <br />� c��z�a� <br />��'�-=--' r .J <br />��- - i -. <br />Phone ��3� � ����'S—" <br />�p�DES�RIPTION: Sewer District <br />"L6��-o-?/-.: w. Bylock 'S�i.2- <br />Plat; ��.ih.� '�i,�„ l (o_ _�. �`' Monthly Sewer Service. <br />Unplatted Description i�lonthly Sewer Constr. <br />-r....,, o.......:.. <br />SEESKETCH ATTACHED <br />INSF'ECTION <br />Latera <br />Abutting Lot Line <br />N. S, E, W <br />Approved By �r% . � '.t-�< /— • � --J <br />Ciry Engineer <br />� � n <br />Issued By��" - � �/,:%`�� �Y/ <br />Inspection By , �. <br />Datelnspected ' � � U <br />No. 23601 <br />