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everett <br />,e <br />City of Everett <br />Sewer Application and Permit <br />NO. 22804 DATE Z '/ <br />CHART NO. ��� r^^e•� <br />® J <br />v�b tg <br />Service Address Utility Account No <br />Billing Address Permit Fee__ <br />City, State, Zip Connectior. Charge <br />Owner (Mortgagor) Total Fee <br />Billing Name____ <br />Connection By--------- - <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />SEE SKETCH ATTACHED <br />Signed <br />Cuslonnu <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 By_ <br />GIy Engineer <br />Issued B <br />Inspection B <br />—_—_ Date Inspected ✓j , <br />NO. 22804 <br />