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evere" <br />o ... <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22546 DATEi <br />Service Address % S J /Jfe• ,_ . <br />Billing Address �/JJ Z �i —i�/`� 17% :lr.. L <br />City, State, Zip_, "'t'�a f yJ" <br />Owner <br />B;Iling I <br />Connec <br />/ I C. <br />Addressl.Sb 2 r. �` <<1-�.�, f��" <br />Phone f. S l i t i< <br />DESCRIPTION: <br />Lot Block <br />CHART NO. ? �� <br />, <br />Utility Account No. 3 5 L <br />Permit Fee_ � �' ," ` <br />Connection Charges) ?� (�S, ? �` <br />Total Fee 6 — <br />%� ,,,� <br />Signed - .'' �-'��.t � % <br />Customer <br />Sewer District y. <br />Plat Monthly Sewer Service �) % :-' f> u` <br />Unplatted Description, '�� / >> �t ' 3-J' S Monthly Sewer Constr. <br />Tvoe Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk `r <br />Lateral S . ,s29 <br />Abutting Lot Line <br />N, S, E, W <br />Approved By y��-,.... <br />City Engineer <br />Issued By , ✓ -" -' <br />Inspection B j ' r"' <br />Date Inspected / —��" �O <br />