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cveretl <br />e <br />City of Everett <br />Sewer A�splication and Permit <br />No. 23630 DATE �� 1/� <br />CHART NO.l'� � � Z`� "s <br />Pasr�v 8 - 2�-� <br />Service Address �-'' � � � ^ ' ' ' ' -' � Utility Account No. <br />Billing Address � � � � � "" � -� � � � � � � Permit Fee <br />City,State,Zip�'� � ! � �A �/�•<.-rZ`-' ConnectionChar��el <br />Owner (Mortgagor) � � � �� � � � � � Total Fee__ <br />Billing Name � �`- � � <br />Connection By �' � � � ` —L' ' ' — <br />�� <br />i <br />,G ,- � , <br />� � <br />: j -�. c� <br />, <br />� _ j • � ' -' Signed � J '�. <br />Address � ( �' —� Customer <br />�_ , , .� . . <br />" r I <br />Phone � ' � � � <br />DESCRIPTION: <br />Lot '�- Block �-- <br />I �+ L <br />Plat L �-__.�._ .. �- 1 �• .� � �__ <br />Unplatted Description <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral__ <br />Abutting Lot Line <br />N, S, E, W._ <br />SEE SKETCH ATTACHED <br />IN�I I c � �oi� <br />.4pproved By ' � ' ' ' .,`i ` .;`1 <br />Cny Engmeer 'I <br />Issued By ! � � � � � <br />/ <br />Inspectiun By � — <br />Date Inspected_(��� --- <br />rvo. 23630 <br />� <br />