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f <br />� everetl <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART NO <br />No. 24353 DATE � � I <br />Service Address Utility Account No. <br />Billing Address Permit Fee ' <br />City, State, Zip Connection Chargels) <br />, <br />Owner (Mortgagor� � Total Fee _ <br />Billing Name <br />Connection By � <br />Address � ' � � Signed _ <br />Customcr <br />Phone � <br />DESCRIPTION: Sewer District <br />Lot_ Block — <br />Plat _ Monthly Sewer Service <br />Unplatted Description _ Monthly Sewer Constr. <br />Trunk <br />SEESKETCH ATTACHED <br />.:�>Pf.(� i ICId <br />Lateral__ <br />Abutting Lot Line <br />N, S, E, W_ <br />t. <br />z <br />Approved By ` � <br />Ciry EnBincer i <br />� <br />Issued By r � � � <br />�' � <br />Inspection By � ' � <br />� i , <br />� � u� ' � <br />Datelnspected �'�' �.% _ <br />� <br />N� 24353 � <br />. <br />� <br />