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everett <br />e <br />City of Evorett <br />Sewer Application and Permit <br />No. 25134 UATE �,L�. rt,_.�oas _ <br />CHART NO. <br />_-:-,,, <. �N�i.cT,,v�.. %,t s,aE <br />Service Address_ sna _ 7S� Di" e�� Utility Account No. <br />BillingAddress a�R cs c.,...,,�. ���wy Pe�mit Fee 30.00 <br />City, State, Zip xw..�r v� oa�i,�_ Connection Chargels�_ 7L,00 <br />Owner(Mortgagor) .�,r.� nii��. TotalPee __���_.__ _ <br />Billing Name s... <br />Connection By +a.s. <br />Address nZs sa c.r�n .» r�y <br />Phone �ss_uc� — — <br />DESCRIPTION: <br />Lot ++� Block <br />Plat M_ <br />Unplatted Desr.ription <br />T...... 0....�:�. <br />Signed _ _ <br />cu:lomer <br />SEESKETCH ATTACHED <br />INSf'ECTION <br />Sewer District_ _ <br />Monthly Sewer Service_ <br />Manthly Sewer Constr. <br />Trunk _ <br />Lateral _ <br />Abutting Lot Line <br />N, S, E, W__ _ <br />Approved By <br />e <br />Issued By <br />Inspection By <br />Datelnspected � <br />rvo. 25134 <br />