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Nd <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22664 <br />DATE <br />Service Address � <br />-- Utility Account No. Lr <br />� '" ; <br />'7J Permit Fee <br />Billing Address <br />City, State, Z.ip <br />7 ,'.. _ / Connection Charge(s) <br />Total Fee <br />Owner (Mortgagor) <br />— <br />Billing Name <br />Connection By <br />— <br />Address <br />_ Signed e_.L %'custorner <br />Phone — <br />DESCRIPTION: <br />Sewer District <br />LotBlock <br />Monthly Sewer Service — <br />Plat <br />Unplatted Description <br />_ Monthly Sewer Constr. <br />Trunk <br />Type Permit: _ <br />Remarks: <br />SEE SKETCH ATTACHED <br />INSPECT ION <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />City Engineer <br />Issued 3y__ <br />Inspection By -- <br />Date Inspected_ <br />NO. ?2G64 <br />