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CHART NO.�� / Z <br />everett <br />,e <br />City of Everett <br />Sewer Application and Permit <br />N0. 22805 DATE <br />Service Address / Utility Account No. <br />Billing Address Permit Fee <br />City, State, Zip Connection Charge(s) <br />Owner (Mortgagor) Total Fee_ <br />Billing Name <br />Connection By <br />Dk <br />DESCRIPTION: <br />Lot Block — <br />Plat -- <br />Unplatted Description ____ <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Signed <br />Customer <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral.____ <br />Abutting Lut Line <br />N, S, E, W <br />Approveo By Eng.-- <br />City ineer <br />Issued By <br />Inspection <br />Date Inspec <br />N0. 22805 <br />t <br />