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everett <br />e <br />City of Everett <br />� '��;� `i -�c � `� <br />Sewer Applica#ion and Permit <br />rvo. 23166 <br />Service Address <br />Billing Address, <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection BY. <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Block <br />DATE <br />CHART N0. J — G �Z � —S <br />Utility Account No, � � " � <br />�- <br />- Permit Fee ' <br />Connection Charge�s) •� �� <br />Total Fee <br />Signed ' <br />Customcr <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />T�unk <br />Lateral � <br />Abutting Lat Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Approved By <br />Ciry Enginccr <br />ISSU2() <br />Inspection By � <br />Date Inspected �7 � � �7 "—�S <br />No. 23166 <br />