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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />No. 23004 <br />DATE - �— � J <br />Service Address '�Lr'�ti.�--•q <br />Billing Address / <br />City, State, Zip <br />Owner (Mortgagor) - � <br />Billing <br />CHART N0. �' � "� �"� <br />Utility Account No. <br />Permit <br />Connection Charge�s� <br />Total Fee <br />�os�0 <br />6 �� -�t <br />: <br />Connection By -- / <br />Address Signed _ <br />/ % , Cus�omer <br />Phone -- <br />DESCRIPTION: Sewer District <br />Lot_ � Block <br />Monthly Sewer Service_ <br />Plat __ <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: - <br />SEESKETCH ATTACHED <br />INSPECTION <br />Trunk <br />Abutting Lot Line <br />N, S, E, W, <br />fy-'_ . ` ( 1 <br />Approved By � <br />Ciry Engineer <br />Issued Ey � <br />Inspection By � <br /><� /' <br />Date Inspected v ��`f' _ <br />No. 23004 <br />0 <br />