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evereH <br />, � <br />City of Everett <br />Sewer Application and Permit <br />No. 23695 DATE —_ <br />8��.�go <br />1710 19th Stt��t <br />Service Address <br />Billing Address <br />City, State, Zip — <br />pwner (Mortgagori --- <br />Billing Name__-- <br />Connection By._ Cit--- Y=t =•�r�tt_ <br />DESCRf PTI ON: <br />Lot_�— glock�— <br />Plat <br />Unplatted Description__ <br />_ .. r�nili <br />CHART N0. Q �a "24-5 <br />�osT� f7 g- 21 �j'J <br />� <br />Utility Account No. <br />Permit Fee�°O—n� <br />Connection Charge(s)_ <br />non� <br />Total Fee.__� <br />�on Mill�r <br />Siyned �ustomer <br />Sewer Uistnct <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />5EE SKETCH ATTACHED <br />Lateral <br />ahutting Lot Line <br />��,S,E,W <br />H. Warrsu <br />qpproved BY ��t� EnBineer <br />E. BonQ <br />Issued By�----- <br />.s..� <br />ti�, g G�,�,�r' <br />Inspection ByL . <br />Date Inspected <br />No. 23695 <br />I�SPECTION , <br />f t. <br />