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everett QX,, 1­4—1 <� <br />/a/e.,ic <br />,.e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22436 DATE / />' 71 <br />Servico Address 110�f <br />Billing Address Q - 74; 7 <br />City, Stale, Zips__ <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />Phone <br />— / ,_:) 1 <br />DESCRIPTION: <br />Lot_x2DBlock_— n <br />Plat //"` <br />Unplatted Description_ _ <br />Type Permit: <br />Remarks: <br />CHART 144 �— <br />;i. <br />r:. <br />c• <br />.lop N1oT8uiz7- <br />A7 ;;?3`7�j c_ <br />c <br />Utility Account No. 3 — 3 S - S6 ,�;' OO <br />Gi <br />Permit Fee �>�'� �' 30 <br />Connection Charge(s) e— -�j 6' I' <br />Total Fee 5 <br />Signed �= i <br />ustonner <br />Sewer District 3 <br />Monthly Sewer Service ' 3 <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved -By 4 <br />City Engineer <br />— — -- Issued By ---- <br />Inspection By - <br />Date I nspecte 7-- <br />SEE SKETCH ATTACHED No. 22436 <br />INSPECTION <br />