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evei ett <br />� <br />City of Everett <br />Sewer Application and Permit <br />rvo. 24847 <br />DATE _— <br />-`�s�- <br />� � i i -=>'7��, f... <br />Service Address.��,. .r---- <br />Billing Address - ' — <br />� ; � � �i .' // <br />City, State, Zip <br />Owner (Mortgagor) � <br />� .� � !"', r_-i��i� /_ <br />Billing Name_, <br />Connection By�- � �-/�L�� ``"�=,L`�"�7-- <br />Address��12-� `' �� � �( E� <br />Phone ._.���."'—.fP�3� _--- <br />i DESCRIPTION: / <br />I Lot�— Block—L—.— <br />, i, �,�–�. <br />I <br />PI2t �' �"G ��� G� <br />; Unpla[ted Description_ <br />CHART NO <br />Utility Account No. <br />v� UO <br />Permit Fee — <br />��� DQ <br />Connection Cha�ye�s1�1L— <br />Total Fee / O OO <br />Siyned '" c��siomer <br />Sewcr Gistrict – <br />Monthly Sewer Sen�ice__ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />SEESKETCH ATTACHED <br />I <br />Approved BV � <br />Ctly E�qinem <br />�'� . � . , , . . � <br />Issued <br />� �. <br />Inspection By - <br />Date lrspected � 7� a�-- <br />No. 24847 <br />i. <br />