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_k I <br />everett <br />,,e <br />City of Everett <br />Sewer Application and Permit <br />No. 23646 DATE June 25, 1480 <br />9509 19th Avenue S.E. <br />Service Addresi <br />Billing Address <br />City, State, Zir <br />Owner (Mortgt <br />Billing Name_ <br />Connection B) <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />City of Everett <br />CHART NO. <br />Fos�e-o <br />4-77—gz <br />C —' <br />Utility Account No._ <br />Permit Fee <br />none <br />Connection Charge(s) <br />none <br />Total Fee <br />Don i4i11er <br />Signed Customer <br />Sewer District <br />Block: Monthly Sewer Service <br />Monthly Sewer Consty. <br />VEW CONNECTION <br />r <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,W <br />r /y7 li H. Wirren <br />Approved By <br />City Engineer <br />E. Bond <br />i Issued BY -- <br />INSPECTION <br />Inspection By—, <br />Date Inspected <br />No. 23646 <br />W <br />