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, . �. <br />everett <br />� <br />City of Everett <br />Sedver Applicatior� and Permit <br />No. 22993 <br />DATE �_ �' <br />Service Address � '' % <br />3illingAddress , �' `'' <br />City, State, Zip � � � � <br />Owner (Mortgagor) /. <br />i <br />Billinu Na�ne ' <br />Connection <br />DESCRIPTION: <br />Lot — <br />Plat <br />Unplatted Descr <br />T...... Dormit <br />Block <br />� <br />CHARTNO. C- r��2�'Y <br />• _ �p�j I:LGY <br />7-I'7- �q, <br />� <br />Utility Account No. <br />Permit Fee_ � <br />Connection Charge�s) <br />Tota� Fee <br />SignOd_ Customer <br />Sewer Uistnct <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />I�ISPECTION <br />Abutting Lot Line <br />N,S,E.W <br />Approved By <br />Ciry Engineer <br />Issued <br />�—" <br />Inspeciion By �'�"`� � <br />r�� ( <br />Date Inspected � �` Y ! �� <br />NO. �2a9� <br />