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everett <br />e <br />City oi Everett <br />e <br />Sewer Application and Permit <br />CHART <br />Pa�T� � <br />g- �e- ga <br />� <br />N0. 24292 DATE � � � <br />Service Address ,i // ' Utifiy Account No. <br />Billing Address _ " Permit Fee <br />City, State, Zip Connection Charge( <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />/, <br />Connection By _ _ <br />Phone <br />DESCRIPTION: <br />lot Bloc�c _ <br />P;at <br />Unplatted Description_ <br />Signed <br />Cus�omer <br />Sewer Disvict 'i <br />Monthly Sewer Service <br />_ Monthly Sewer Constr. <br />' Trunk ; <br />Lateral_ <br />SEE SKE7CH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W, <br />it. <br />A pproved By <br />Ciry Enginccr <br />Issued By i � <br />;1 <br />i (/ _ <br />Inspection By -'y �1 ��-"'�,,^ ,'1 fA�, _ i <br />r , ! <br />i <br />Datelnspected � � ��' /��� =—l` � <br />No. 24292 'i <br />� <br />w, <br />