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everetl <br />� <br />City of Everett <br />Se�aer Apploceation c�nd Permit <br />N��� 23089 DATE � <br />CHART NO- -I - � � �- ��- "t <br />� <br />���� <br />Service Address �" ' � ! t� - i' . " r��� : � � � .+<Utility Account No. <br />Biliing Address Permit Fee <br />City, State, ZiP Connection Charge(s)_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection <br />;.. <br />i;: . ' �- % .. — ;) <br />Phone ! � - <br />DESCR I P71 ON: <br />Lot i _ Block—� <br />Plat ` <br />Unplatted Description <br />Tvoe Permit� . . -� <br />� <br />Signed <br />Customcr <br />SEESKETCH ATTACHED <br />WSPECTION <br />Sewer Distrir,t <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />�� <br />Abutting Lot. Line <br />N, 5,,, E,. W ft. <br />Approved <br />City Engineer <br />Issued By _ <br />I� <br />Inspection By '-�l��i •�(� <br />Date I nspected (J � L.' '�/ L J/ <br />No. 230a� <br />