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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23144 DATE���� <br />CHART NO. <br />p -Lep <br />,0 <br />Service Address `3 '? O/ LX L Utility Account No <br />Billing Address Permit Fee _ <br />City, State, Zip— > `YAW Connection Charge <br />Owner (Mortgagor( Total Fee <br />Billing (Jame_. <br />Connection By_ <br />Address_ <br />Phone <br />DESCRrON: <br />Lot Block <br />Plat i - , .� <br />Unplatted Description_ U _ <br />SEE SKETCH ATTACHED <br />Signed <br />Gmtomer <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By <br />Date Inspected _ <br />No. 23144 <br />INSPECTION <br />-;- U <br />i <br />