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evereH <br />e <br />City of Evorett <br />Sewer application and Permit <br />No. 23147 <br />CHART NO. <br />V. <br />�13 <br />DATE 'X'-/ /I__ <br />Service Adoress 1 r� <br />Billing Address. <br />City, State, Zip_ <br />Owner (Mortgagor)_ __ <br />Billing Name _ <br />Connection By <br />Phone_ <br />DESCRIPTION: <br />Lot _ Block <br />Plat <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee <br />Connection Charges) <br />Total Fee <br />Signed <br />Cuslomer <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued By _ <br />Inspection By =��11 )—,-1) 1.2 <br />Date Inspected Y / — 79 <br />N0. 23147 <br />