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eD <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 92559 DATE �K /3- 7Y <br />Service Address _4-DU 4l <br />Billing Address d aol' ?!:z" 6z1 <br />r"1 <br />City, State, Zip <br />Owner (Mortgagor) - - <br />J / <br />Billing Name <br />Connection By — <br />Phone 3 3 7 - '71�;al? <br />CHART N� - <br />�OST <br />/>--2-C-?Sr' <br />Utility Account No. <br />Permit Fez 3 D <br />v-r <br />Connection Charge(s) <br />Total Fee <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block <br />Monthly Sewer Service <br />Plat <br />Unplatted Description -! GY /lel Mont:.!v Sewer Constr. <br />Trunk s 0 <br />Type Permit: -2/.._ . — < -,, . /. _ . <br />Remarks: <br />3 <br />SEE SKETCH ATTACHED <br />Lateral :-+5- 7-"7" JYO.60 <br />Abutting Lot Line <br />N, S, E, W <br />Approved B� =- <br />City Engineer <br />Issued By. <br />Inspection <br />Date Inspected_- <br />NO. <br />iNSPECTION <br />i <br />