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everett <br />em <br />City of Everett <br />Sewer Application and Permit <br />NO. 23408,clod' DATE 1 ��'-, I / � <br />Service Address S <br />Billing Address <br />CHART NO. .._-_-- <br />i <br />Utility Account No <br />Permit Fee '?o 00 <br />City, State, Zip <br />Owner (Mortgagor) <br />/--C 6' <br />Connection Charge(s)_ <br />•Total Fee <br />92 0 o <br />/ r/. , i.t, _1 <br />Billing Name + i '' '"id " <br />Connection By - [_i r-� r <br />(' Signed <br />Address � C .r r' ` "' en <br />.I -. - I /ir <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Block <br />SEE SKETCH ATTACHED <br />Sewer District <br />Month!-; Sewer Service - <br />Monthly Sewer Constr. <br />Trunk <br />Lateral — <br />Abutting Lot Line <br />N, S, E, IN ft <br />Approved By e <br />t L <br />/City Engineer <br />Issued By <br />Inspection By— tl <br />Date Inspected 1 2 12' ! %- <br />No. 23408 <br />INSPECTION <br />