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� J C. <br />everE�ri ti� c -i?-� S <br />� <br />City of Everett <br />Sewer Appliccation and Permit <br />No. 23241 <br />DATE - <br />Service Address % �' � ' <br />Billing Address " �' <br />City, State, Zip <br />Owner (Mortgagor) r ` <br />Billing Name <br />Connection By -- <br />Address <br />Fhone � �� Y' i � � <br />DESCRIPTION: <br />Lot " -- Block '� <br />Piat <br />Unplatted Description <br />Type Permit: <br />CHART NO.�.-�7-�-� <br />�� �� � � <br />ii- �-�f <br />� <br />f Utility Ar.count No. <br />Permit Fee `% - <br />Connection Charge�s) - ^ ^ � <br />Tota I <br />Signed � <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />l"runk <br />La[eral <br />Abutting Lot Line - <br />N, S, E, W"'� i ft. <br />/' —� <br />Approved By' <br />Ciiy Engineer <br />Issued By ' <br />� _ <br />, I <br />Inspection By � � � � �� <br />Date Inspected /n — 9 - 7 �% <br />No. 23241 ' <br />