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evere" <br />,,e. <br />City of Everett <br />Sewer Application and Permit <br />No. 24069 DATE <br />Service Address - / o��-- <br />Billing Address <br />City, State, Zip /tea ' J—��" -3 <br />Owner ( <br />Billing <br />Connection <br />Address_ _ �/�' A,`�^�"'q� `� <br />Phone ✓� S s 67— <br />DESCRIPTION: <br />Lot Black <br />Plat <br />Unplatted Description <br />Type Permit: %P r <br />Remarks: <br />SEE SKETCH ATTACHED <br />CHART NO.- <br />Utility Account No. <br />Permit Fee_ lr[—� — <br />Connection Charges)-30 <br />Total Fee 3 O — <br />Signed <br />Custarnly <br />INSPECTION <br />Sewer District <br />D <br />Monthly Sewer Service__ '� <br />Monthly Sewer Constr. <br />Trunk a•a? y <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By�✓f' <br />City Engineer <br />Issued By <br />Inspectio G <br />Dati'Ins pected�//''� — r Z <br />No. 24069 <br />1A <br />