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ki <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 21.70 DATE �L; i 7 <br />Service Address ✓ 4 7471., t�r - <br />Billing Address �L� 77G 7 0" s r� <br />City, State, Zips <br />Owner (Mortgagor)7%/� <br />Billing Name — <br />Connection By <br />Address �L��' <br />Phone -!,'' C <br />DESCRIPTION: <br />Lot ':�, / Block - <br />CHART NO. <br />i <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee �r�• DU <br />Signet}y,/0-4-4-�._.._�.-G� __ S <br />Cwtomer <br />Sewer District `G 41 <br />Monthly Sewer Service <br />Plat <br />Unplatted Description ///!// is ��/� f�� �' Monthly Sewer Constr. <br />Trunk <br />Type Permit: it/:7u <br />--I Lateral �L_•'L '`� <br />Remarks: Abutting Lot Line <br />IN, S, E, W <br />PP L..c/.v'.:�. c/ <br />Approved By <br />City Enpineer . <br />Issued By L ` �LL�cJl�tl�v <br />i <br />i <br />Inspection <br />Date Inspected L— <br />SEE SKETCH ATTACHED NO. <br />INSPECTION ` <br />