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eNeretS <br />e <br />City of Everett <br />S�wer ��pplicatior� and Permit <br />rvo. 231$4 <br />Service Address ! <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />CHART �0. � �6-a� 4�— <br />�-�3��� <br />�a'rE ; �'. ' % / � <br />_ Utility Account No. <br />- Permit Fee <br />Connection Chargels) <br />Total Fee <br />_ Si9ned_ <br />Phone — <br />DESCRIPTION: Sewer District ' --- <br />Lot � Block % � <br />Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Tn�nL i � <br />Type Permit: — <br />SEE SKETCH ATTACHED <br />INSPECTIOIJ <br />lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By --� <br />Ciry Enginecr <br />Issued <br />Inspection By `-��T�^" � � <br />Date Inspected � � � r � ��� <br />rvo. 23Y$4 <br />