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everett <br />e <br />City of Everett <br />Sewer Applicotion and Permit <br />NO. 23181, DATE <br />Service Address ' <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection BY <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />CHART N0. � - G,— �v' � <br />Utility Account No. <br />Permit Fee <br />Connection Charoef <br />Total F <br />Signed <br />SEE SKETCH ATTACHED <br />INSP[C110N <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engincei <br />I ssu ed <br />Inspection By ` <br />Date Inspected <br />N�. 23181 <br />