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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 25176 t,FT GOA� <br />-744kf:i— <br />Service Address' Utility Account No. — <br />Billingi,ffMes Address Permit Fee ,50 C)L9 <br />City, State, Zip A4V/s111, P/C (/l I ) Connection Charge(s) �j� - Q <br />Owner (Mortgagor) PA k ( DA / 0 Total Fee � 0 —(30 -- <br />Billing Name_, ue <br />Connection By <br />Address /� bo► e. — <br />Phone 1 300 — <br />DESCRIPTI N: <br />Lot I I Block <br />Plat <br />Unplatted Description_ <br />Type Permit: IL <br />Remarks: <br />SEE SKETCH ATTACHED <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By <br />Gty Eng,nrer <br />Issued <br />Inspection By—N <br />Date Inspected_��E <br />No. 2�5176 <br />