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City of Everett <br />CHART NO.; I2-26 S <br />jc 'a D <br />1-20 S <br />619t - <br />Sewer Application and Permit <br />No. 23838 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />f <br />Billing Name (t - <br />Connection By I Lh <br />Address <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description — <br />Utility Account No <br />Permit Fee — <br />Connection Charge(s)( ` I <br />Tetal Fee <br />Signed_ <br />SeNer District__ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />NN, S, E, W <br />Approved Ely I I -- <br />City Engineer <br />Issued By <br />Inspection By <br />Date Inspected�� — a <br />No. 23638 <br />