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ev2rett <br />� <br />City ci Everett <br />�ewer A�pli�cati�►r� and P�rmifi <br />N�. 23528 D/\TE �f /`''j ;�' � <br />� <br />/ , <br />CHART N0 �• <br />,, , ,— <br />-��, �,,.% <br />Service Address 'S `"' ' � '� "J (- ": -: : Utility Account No. _ � =� �'� �' � ''� <br />Billing Address_�'"d� �=- _ Permit Fee_ ">: ?�� <br />City,State,Zip�-�-t��-r'��Y,ii , l�lc, i Connection Chargels) �'l� �-'l <br />� ,r <br />Owner (Mortgagorl!-�� -�C L=S,� •i/ Total Fee �:'- � <br />Billing Name_� �_ <br />Connection B <br />Address <br />DESCRIPTION: <br />Lot N Block__ <br />Plat ,� �� <<'��"i� _ �?„�:= <br />Unplatted Description _ <br />Type Permit: <br />Signed <br />SEESKETCH ATTACHED <br />ii-!'�I'L C1 If;i � <br />SewerDistrict y � �sl;;:-a(` � <br />Monthly Sewer Service. � � <br />Monthly Sewer Constr. <br />Trunk <br />Lateral__ <br />Abutting Lot Line <br />N, S, E, W_ <br />�� <br />Approved By �•' i = ..•; <br />Ciry Engineer <br />� , . <br />(SSUetl By G. {'' �-i .%_',.., " <br />Inspection ByS � 1 ��`�� �ti� <br />�ate Inspected__ '" / -C�� '' v <br />rvo. 2352� <br />