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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />Utility Account No._ <br />Permit Fee _ <br />Coni�ection Charge <br />Total Fee-----..-- <br />N0. 22970 DATE _ <br />Service Address , <br />_illing Address � = — <br />City, State, Zip ' <br />Owner (Mortgagor) <br />Billing Name <br />Connection By__ -- <br />Pho�e __ <br />DESCRIPTION: <br />Lot Biock <br />Plat � <br />Unplatted Description _ <br />Type Permi[: <br />�- � /� ( . <br />CHART N0. �,1 r <<, � . <br />SEE SKETCIi ATTACHED <br />INSPf Cl I�IJ <br />� <br />Sewer District___—_ —_--; <br />MonthlySewerService____ —______ <br />Monthly Sewer Constr. <br />Lateral <br />Abu[ting Lot Line <br />N' '�'• E' ��--- --- <br />Approved 8 <br />City Engmccr <br />ISSUC(J B <br />Inspection By "��'--�__� �` � <br />c� �� �� C.] L.� <br />Date inspected `S__.� ' ' _-- <br />I�O. 22970 <br />