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4/0 Al1, 1015 <br />end <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 21.866 DATE ;? 'i /277 <br />CHART NO.1, ' <br />Service Address O 33 � '` ' � ' Utility Account No. 2 Y 60 <br />`T 7' <br />i <br />Billing Address <br />A" R ' Permit Fee 3D <br />6ti�t/�r J�Connection Charge(s) <br />City, State, Zip—=-- <br />f��j' O v <br />Owner (Mortgagor) _ rY E% fi ^'" ' "� Total Fee 3D <br />Billing Name <br />Connection By J i� �M r <br />Phone. <br />`>15Fi - ` 34C1 <br />DESCRIPTION <br />Lot Bloc <br />Plat t4l '�— <br />Unplatted Description <br />Signed /�'/ •'� �' ` `� _ <br />% Customer <br />Sewer District' SD <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By R - /Su c /C <br />Date Inspected_ ��� Q�� % <br />No. 21866 <br />