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Ed] <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. �t <br />:tr C <br />��— <br />Z) 1 <br />No. 23460 DATE <br />6 — <br />Utility Account No.—, <br />Service Address <br />Permit Fee <br />Billing Address <br />' <br />Connection Chargelsl�------- <br />City, State, Zip <br />3 0 <br />Owner (Mortgagor) _�-( <br />Total Fee <br />Billing Name <br />Connection By f <br />Address <br />rz Joe <br />Phone 7g _ /c/ — <br />DESCRIPTION: <br />Lot Block — <br />Plat <br />Unplatted Description - <br />Permit: <br />Remarks: <br />Signed_. cmrome. <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 />SEE SKETCH ATTACHED <br />INSPECIION <br />Approved BY-T caw/„a�«� <br />Issued By Al<--1 /f <br />Inspection Byl <br />Date Inspected <br />NO. 23460 <br />J <br />