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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />n,o. 23142 DATE � r � <br />,-- �� � i /� f%!� <br />CHART N0. D�S-�i�'S <br />Service Address �`�' ���'uT"� Utility Account No. <br />Billing Aduress� Permit Fee <br />City, State, Zip Connection Charge(s). <br />Owner (Mortgagor) Total Fee__ <br />Billing Name <br />Connection Bv <br />Address S <br />Phone <br />DESCRIPTION: <br />Lot � `� Block� <br />Plat <br />Unplatted Description <br />I Type Permit <br />� Remarks: <br />SEESKETCH ATTACHED <br />CD _ �+ --i i <br />INSf'LC iI <br />�- � – <br />Sewer District __ _ _ ___ <br />Monihly 5ewer Service__ _ _ — <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W it. <br />Approved DY <br />c��v e���n,,,.,., <br />Issued l3y <br />Inspection By— - _ <br />Date Inspected <br />23142 <br />