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1 <br /> CHART N0. <br /> everett . <br /> � <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. 22814 DATE (/ �i / <br /> Service Addreu " 1�� —?��— Utility Account No. <br /> BillingAddress �"? - / '��� Permit Fee �l � � � <br /> City,State, Zip ' ;" __ Connection Chargels) <br /> v <br /> Owner (Mortgagor) � ' Total Fee � � <br /> Billing Name <br /> Connection By / I <br /> �. �-- / <br /> Adc:ress�il i / ,/�/ 9igned��_�� <br /> � � <br /> Phone !' <br /> DESCRIPTION: Sewer District <br /> Lot �� / Block / '� <br /> Plat —' ' � j�_ Monthly Sewer Service._ <br /> j c <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: ' , Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ic. <br /> , Approved By <br /> cnr e�o����. . <br /> . Issued E3y <br /> Inspection By _ <br /> Date I nspected <br /> SEE SKETCH ATTACHED NO. 22814 <br /> _, __ _ IN51`tir'T�IN <br /> ___ .. _ <br />