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eW <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />Na 22490 DATE <br />Service Address le 0 lf— <br />CHART NO. - - <br />- Utility Account No._3 - <br />Billing Address --r Q / / - <br />Permit Fee ✓ O <br />City, State, Zip <br />_ . onnection Charge(s)_ Za <br />Owner (Mortgagor)--.' <br />Total Fee a O <br />Billing Name - <br />Connection <br />Phone_ �� �- �i — �� G f: <br />DESCRIPTION: <br />Lot J Block <br />Plat:_ <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />9 <br />11 <br />SEE SKETCH ATTACHED <br />O � IDlSPCCTIOP.I <br />Signed ~7 <br />Cus'oi; r -- <br />Sewer District .-' <br />D .!L <br />Monthly Sewer Service_ 0 <br />Monthly Sewer Constr. <br />Trunk_ / / �r /p <br />La,eral <br />Abutting Lot Line <br />N,S,E,W, <br />City <br />Issued By <br />Inspection By—' //(.0 4nl <br />Date Inspected <br />NO. <br />