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a <br />evereH <br />�e� <br />City of Everett <br />Sewer Application and Permit <br />NO. 22821 <br />DATE <br />Service Address <br />Billing Address <br />City, State, Zip _ <br />Owner (Mortgagor) --- <br />Billing Name <br />Connection By <br />M. <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Remarks: <br />Block <br />SEE SKETCH ATTACHED <br />CHART MO. 1-2— /Z - -2� y <br />Utility Account No. <br />Permit Fee <br />Connection Charge( <br />Total <br />INSPECTION <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 <br />City Engmeer <br />Issued <br />Inspection B <br />Date Inspected 1 JJ/ <br />No. 22821 <br />i <br />