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everett <br />� <br />City of Everett <br />Sewer ,Application anc� Permit <br />No. 24116 DATE qnv�,. � ��� . <br />Service Address�T_}g�� <br />6illing Address <br />City, State, Zip <br />Owner (Murtgagor) <br />Billing Name <br />Connection By ��p�,��,R••�� <br />Phone <br />DESCkIPTION: <br />Lat Block_ <br />Piat <br />Unplatted Description_ <br />CHART N0. <br />Utility Account No. <br />Permit Fee p�gps <br />Connection Chargel5)__ <br />Total Fee �q <br />Signed <br />us amer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Canstr. <br />Trunk _ <br />SEE SKETCH ATT�\CHED <br />INSPECTION <br />wtting Lot Line <br />N, S, E, W <br />>proved By�Lu,��— <br />cn4'EngiA <br />ued By c�,>•��e Grannan <br />/ � - 7-�- <br />spection By l i• G /%�n r.,,• <br />telnsaected ��-�'�-'�� _ <br />No. 24116 <br />