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everetl <br />� <br />City of Everett <br />Sewer ApplicQtion and Permit <br />CHART N0. �-"�-�'S — <br />� <br />�.��y�-� <br />�� <br />�c�%- �1-79 <br />N0. Z31ZH DATE � ��T — � <br />Service Address.��� �-5 "�9 'u�'` � Utility Account No. <br />Billing Address_ _— Permit Fee__ <br />Ciry, Statc, Ziu__ Connection Chargel <br />Owner (Mortgagor) _ J Total Fee <br />Jilli^- Name <br />Connection By_ � <br />_ S�gned <br />Phone � <br />DESCRIPTION: <br />Lot B lock <br />Plat _ <br />Unplatted Description f� <br />Tvnn Pormit• � � <br />SEESKETCH ATTACHED <br />INSPGC110N <br />,/ <br />_�— <br />Sewer Distnct _ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Laterai <br />Abutting Lot Line <br />N, S, E, W. <br />Ap��roved By �' <br />Gty Engmxer <br />� SSIICd <br />Ins�ection By— <br />Date Inspected_ <br />—� <br />No. 23i2$ <br />