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i evereft <br />City of Everett <br />j Sewer Application and Permit <br />N0. 22850 DATE• / <br />CHART NO. ! Z yZg " 5 <br />�5 <br />Z-ZG 7S <br />)9 <br />Service Address _ Utility Account No. <br />Billing Address_ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address_ _ <br />Permit Fee - <br />Connection Charge(s) <br />Total F <br />Signed <br />DESCRIPTION: <br />Lot__ Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />1 <br />Remarks: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer <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 />City Engineer <br />Issued <br />Inspection By 1 <br />Date I nspected_� <br />NO. 22850 <br />