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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 22823 <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 />DATE <br />CHART NO.Ar j <br />1-2.3 <br />44' <br />'Utility Account No. <br />Permit Fee --- <br />Connection Charge(s) <br />Total Fee -- <br />Signed — <br />customer <br />Sewer District _ <br />Block Monthly Sewer Service. <br />Monthly Sewer Constr. <br />-- - Trunk <br />Remarks: <br />5/ <br />-- CITV nr...`.......... <br />` )btic IV kVfRETT.... <br />SEE SKETCH ATTACHE[ s Depf <br />INSPLCIIU4 <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Cay Engineer <br />Issued <br />4 <br />Inspection Q <br />-- <br />Date Inspected /—/Op- — <br />No- 22823 <br />I <br />