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ei <br />City of Everett <br />Sewer Application and Permit <br />NO. 22879 <br />Service Address. / 70 7 <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DATE _e0— Z % 7 <br />CHART NO. %L l7 <br />�l <br />3 - 9-"� <br />9V <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee_ <br />Signed i <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block <br />Plat _ Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, Vl ft. <br />Approved By <br />City Engmee, <br />Issued Bv. 117 <br />Inspection By __ -42z ✓�% <br />)ate Inspected <br />ND. 22879 <br />C <br />