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everen <br />e � <br />City of Everett <br />Sewer ApNiication and Permit <br />No. 25553 DATE _ - <br />Service Address �� ��(�� Utility Account <br />CHART <br />,SE�vT 7o CNA,�'r�ti.� <br />BillingAddress�` �- ��.. ''; `` � /"'' / –�_ PermitFee �:� �� <br />CitY. Siate, Zip'_— i � � ; `I i ' ; .''. , . <br />�_ <br />Owner(Mortgago:) %�� � <br />Billing Name_ _ �-- <br />Connection <br />Connection Charge�s) � /O � <br />Total Fee -��� �% � <br />, __�. <br />Atltlress Signed_ – _ <br />, -. �� � custorr�r <br />Phone ,` /� � � � �� ' '` <br />DESCRIPT ON: Sewer District _.----- <br />Lot Blo k <br />Plat < �— Monthly Sewer Service <br />Unplatted Description ' Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Tru <br />Abutting Lot Line <br />N, S, E, W, <br />_ i. <br />Approved By __. <br />City Enpineer <br />I SSU CCJ <br />l�? <br />Inspection B��;,�- <br />Date I nspected .3'" � '� 7 <br />INSPECI'ION <br />N�. 25553 <br />