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e0rett <br />,e <br />City of Everett <br />Sewer Application and Permit <br />NO. 24008 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address — <br />Phone <br />DESCRIPT.IN: <br />Lot Block_ <br />Plat - <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />CHART NO. G 12-Z8-y <br />P0STJ--1D 10-23-ii/ <br />Utility Account No.LG�'�-� <br />Permit Fee <br />3 Connection Charge(s) 330— <br />c <br />,y_ <br />Total Fee 3e <br />Signed <br />Customer <br />Sewer District aauz Af " <br />Monthly Sewer Service 610 <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved 8yTc �v E o �eN u� <br />Issued By 4- <br />I,tspection By <br />Date Inspected 3UL�( <br />No. 24008 <br />INSPECTION <br />