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evereri <br />� <br />City of Everett <br />Se�rver Application and Permit <br />rvo. 24151 DATE 1/as/a2 <br />7009 21st 5treet <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billiny Name <br />� Citp of Svasett <br />Connection By <br />CHART NO. ' � -',� - ; - _ <br />Utility Account No._ <br />Permit Fee <br />aoae <br />Connection Chargels)_ <br />none <br />Total Fee <br />Don Millez <br />Sig�ed_ Custamer <br />DESCRIPTION: Sewer Distnct <br />Lot B�OC� Monthly Sewer Service. <br />Plat _ <br />Unplatted Description Monthly Sewer Constr. <br />_ ..___... reva <br />SEE SKETCH ATTACHED <br />Lateral <br />qbatting Lot Line <br />N, S, E, W <br />A. R. Theal <br />Approved BY CiW Engineer <br />g. Bond <br />Issued By <br />�� <br />Inspection By , �'� ��'/ , , <br />� s / - '+� 1r <br />Datelnspected — <br />No. 24151 <br />INSPECTION � <br />