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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22173 DATE " 1- 31- 7c� <br />CHART <br />3 3a *7(5 <br />Service Address :3 &1 J 3 " ^ ` r •5Zulity Account No. <br />Billing Address 13 Permit Fee <br />City, State, Zip '' '{✓ `� t �� Connection Charge(s) <br />Owner (Mortga(or) �!�%d� Total Fee —30 — <br />Billing Name <br />Connection 9, <br />Address // <br />Phone -, 37 " 775 <br />DESCRIPTION: <br />Loth— Block Aye' <br />Plat <br />')nplatted Description -- <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Signed !/cam <br />Customer <br />Sewer District <br />Monthly Sewer Service .... <br />Monthly Sewer Cons;- <br />Trunk — <br />Lateral <br />Abutting Lot Line <br />N S E W— <br />Approved B, ' <br />city Engineer j <br />Issued By <br />Inspection By l'�✓LLa�- <br />Date Inspected `2 Y7 <br />NO.a..." <br />INSPECTION ■ <br />