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everetl <br />�e <br />City of Everett <br />Sewer Application and Permit <br />NO. 23145 DATE 3 <br />Service Address�Utility Account No <br />CHART NO. Q—��"S <br />- c <br />Billing Aodress� Permit Fee <br />` <br />City, State, Connection Charge(s)_ <br />S � <br />Owner (Mortgagor) Total Fee_ <br />Billing Name_ <br />Connection By <br />Signed_. <br />Customer <br />DESCRIPTION: I Sewer District <br />Lot Block <br />Plat Monthly Sewer Service <br />Unplatted Description_ ' Monthly Sewer Constr. <br />Type Per, it; Trunk <br />_ 2 Lateral <br />rk — Rema-- <br />Abutting Lot Line. <br />W ft. <br />Approved By_ <br />City Engineer _ <br />7) 7 <br />Issued By <br />Inspection By <br />Date Inspected_ <br />SEE SKETCH ATTACHED No. 23145 <br />• INSPECTION <br />