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Ieverett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22629 DATE � � �' <br />Service Address '� ' - <br />8illing Address ' <br />City, State, Zip <br />Owner (Mortgagor) <br />3illing Name - <br />Connection 9y � - `"' - ' <br />_; <br />Address �" ' " '� _ <br />� — , — r� <br />D6...... ' ' . . <br />DESCRIPTION: <br />Lot _ Cilock � <br />Plat `__ <br />Unplatted Description� <br />Type Permit: <br />Remarks: <br />Utility Account No. � <br />Permit Fee <br />� <br />Connection Charge(s) � <br />Total Fee � <br />! <br />SEE SKETCH ATTACHED <br />INSPECTIOf I <br />0 <br />�., <br />�/..� i�.i >, - <br />Cusromcr <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk_ '— <br />_) — <br />ibutting Lot Line <br />N, S, E, W. <br />Approved By <br />crtv Enginccr <br />Jssued B <br />Inspection By_ <br />Date Inspected <br />� `� X ,�;,•. a.< . <br />