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CHART NO.__ <br /> � everett <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 24621 DATE <br /> Service Address <br /> '> Q Z* /i.w. ((� tility Acco,,nt No.��7 / <br /> ' Permit F, <br /> Billing Address�7�`T" 'v �—=-- — �- <br /> City, State, Zi�� `� r ��c1 ���-- Connection Charge(s)— "2 74 <br /> Owner (Mortgagor) {� LTotal Fee_ 30 00 <br /> Billing Name--- <br /> Connection <br /> ame _Connection By — r <br /> Address_----- Signed <br /> Phone— <br /> Sewer District <br /> DESCRIPTION: <br /> Lot lor_k Monthly Sewer Service 6' S <br /> ...platted Desch ption Monthly Sewer Constr. 0=_ <br /> n Trunk r 7� <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N S E W_ ft. <br /> Approved By t / <br /> City Engineer / <br /> Issued By <br /> Inspection By4&T Date InspecteA <br /> SEE SKETCH ATTACHED NO• 24621 <br /> INSPECTION <br /> t <br />