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CHART N0. <br />evergtl <br />�e <br />City of Everett <br />Sewer Application ana Permit <br />N0. 23Zi6 DATE i ' . ' / <br />Service Address `��� � ��1�-��-'-����� ��' Utility Account No. <br />� <br />Billing Address � � %� Permit Fee_ <br />City, State, Zip ' ' Connection Charge� <br />� L� Total Fee <br />Owner (Mortgagorj , . <br />Billing Name <br />Connection <br />Phone <br />DESrRIPTION: <br />Lot <br />Plat <br />Unp <br />9 <br />f. <br />Signed '� <br />customer <br />Tvne Permit: <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />acv e�e����� <br />I ssued <br />Inspection By '� � <br />Datelnspected �� � � — � 4 <br />No. 23216 <br />