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ei <br />City of Everett <br />Sewer Application and Permit <br />No. 23014 DATE <br />CHART NO. <br />Service Address <br />Utility Account No. <br />Billing Address <br />_ Permit Fee <br />City, State, Zip <br />Connection Charge( <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot Block <br />Plat _ <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Signed <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />`Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />Date Inspected <br />No. 23014 <br />