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ever�tt <br />e <br />City of Everett <br />5ewer Application and Permit <br />NU. 23108 DATE <br />5ervice Address <br />Billing Address <br />City, Stzte, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION� '�I� <br />Lot �''�L� Block �� <br />Plat � �(s( .��jr <br />Unplatted Description <br />Type Permit: <br />CHART N0. �9 � / <br />��+�"�'p° � <br />���5 <br />� <br />Utility Account No. (�Q_� (� <br />Permit Fee <br />Connection Charge�s) <br />Total Fee <br />SEE SKETCH ATTACHED <br />GI:' GCTIOW <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />� <br />Trunk �f 5 <br />Laterai '7-�� <br />- r- — <br />Abutting �ot Line <br />N, S, E, W. <br />Approved By <br />Ciry Enginccr <br />ISSUBCi <br />�1 <br />Inspection By ' �'�-��'�n `'✓�, <br />Date Inspected �`��' 7 y lJ <br />rvo. 231��8 <br />