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cverctl1 <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. 22162 DATE <br />Service Address !el- r' :: -1 • T <br />Billing Address_ L) C 1)) g 41 '/ <br />City, State, Zip/!/l L /1 <br />Owner (Mortgagor) <br />Billing Name ' t "IL <br />Connection By a »L <br />Phone-_ 5 3 — 3 7-- <br />DESCRIPTION: <br />Lot Block -- <br />Plat , <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />CHART NO.QJJF�Z ~ — <br />Ro S?z 1) <br />6 -- <br />96 <br />Utility Account No. <br />Permit Fee <br />Connection Charge( <br />Twal Fee_ <br />Sinned <br />Customer <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By i ' , t <br />cnv Engineer <br />- --- --- — — —� Issued By--,'(-_ <br />SEE SKETCH ATTACHED <br />Inspection By AP23 ,C�.� �• - <br />Date Inspected / .30 zz <br />NO. 1i;J <br />