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everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22786 DATE / �/ � 2/2 <br />CHART NO. <br />1 m <br />' 3- <br />Service Address Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortga <br />Billing Name <br />Connection B, <br />Address <br />Phone _ <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />a <br />SEE SKETCH ATTACHED <br />,. <br />Permit Fee_ <br />Connection Charges( <br />Total Fee <br />Signed <br />INSPECTICI: <br />�J Customer <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 1 <br />City Engineer - <br />Issued By �: �.i'.• <br />Inspection <br />Date Inspected z� <br />NO. i ) <br />