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everett ` <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 24587 <br />xxx �/��e3 <br />DATE <br />Service Address 1011 35th Street <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By City of Everett <br />Address <br />Phone <br />DESCRIP'rION: <br />Block <br />Plat <br />Unplatted Description <br />CHART N0.—,� <br />� <br />0 <br />0 <br />O <br />O <br />0 <br />a <br />Utility Account No. <br />Permit Fee �"°ne <br />Connection Charge�s) <br />Total Fee i�one _ <br />Signed Don Miller _ <br />Customer <br />Sewer Disvlct <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By A. R. Theal _ <br />City Engincer <br />E. Bond <br />Issued Bv <br />Inspection By � � <br />Date Inspected� �� <br />- � No. 24587 <br />Y�osrEO <br />CUST06",L=R COPY R�� <br />� <br />� <br />