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i <br />evereH <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 22929 DATE <br />Service Addresses �(J <br />Billing Address / <br />City, State, Zip ._ <br />Owner (Mortgagor) ' <br />Billing Name <br />Connection By <br />Phone <br />DESCRIP ]'!ON <br />Lot J Block. - <br />Plat i <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />CHART NO.—P— ZB "y <br />o sJ <br />Utility Account No <br />Permit Fee_ <br />Connection Charges)____ <br />Total Fee <br />Signed <br />Customer <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 />Engmcer <br />Issued B <br />Inspection B C <br />Date Inspected <br />NO. 22929 <br />,' 1 <br />