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everett � <br />e� <br />Cirr of Everett <br />Sewer Application and Permit <br />No. 23003 DATE �- : �%i <br />�� � <br />CHART NO.� �' ' ��- 7_ <br />Service Address ' +u Utility Account No. <br />Billing Address � Permit Fee <br />; �- ; <br />, � <br />City, State, Zip Connection Charge�s) '� <br />Owner (Mortgagor) � Total Fee r __ <br />Billing Name <br />Connection <br />Address <br />Phane <br />� <br />/^ /` �. <br />; ,. ,, . <br />, ,- :. ; <br />. , <br />Signed --•. j ; , _ �: :- <br />/� <br />' Customer <br />i <br />DESCRIPTION: Sewer District iC ' / <br />Lot Block — <br />Plat Monthly Sewer Service <br />Unplatted Description ' __ Monthly Sewer Constr. <br />Trunk - <br />Type Permit: - <br />SEE SKETCH ATTACHED <br />le <br />INSPECTION <br />Lateral ' <br />Abutting Lot Line <br />N, S, E,' W � ft. <br />Approved By <br />Ciry EnBineer . <br />I ssued <br />Ins ection B y'l/ <br />P Y� <br />Date Inspected_ S - �4 � / % <br />No. 23003 <br />i <br />