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CHART NO. — �=� - �% 5 <br />evereri <br />� ,'' ��a / C � <br />City of Everett � / � D �% <br />t.1�;3 <br />. . ; <br />Sewer Ap�licc�t�on and �err�et <br />NO. Z3QZJ DATE =� % �— <br />Service Addre;;__ _ i % Utility Account No. <br />Billing Address _ _ Permit Fee <br />i <br />City, State, Zip Connection Charae( <br />IOwner (Mortgagor) ___ 7'otal Fee <br />Bill'.ng fJame <br />Connection By _ <br />i- <br />I Address _ Siyned,� <br />Phone_ <br />u <br />DESCRIPTION: Sewer District ' <br />Lot Block_ ! <br />Plat Monthly Sewer Service_ �i <br />Unplatted Description Monthly Sewer Constr. � <br />� Tru lk � <br />Type Permit: — <br />L:+teral <br />Reraarks: , �,- /r �i ' - ;- <br />r� _�. / _ �!: <br />� <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />_' i, . N, S, E, w ft. <br />i�a,'� i � <br />Approvec? BY_ -- <br />City Er.3inezr <br />Issued 8y _ i <br />II <br />r — � <br />Inspe�,iun By i;� /%/-� . �. ,7'_ <br />Date Ins{_ecied � " ' %% __ <br />N�. 23025 <br />