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l <br />City of Everett <br />Engineering & Jonununity Services <br />Sewer Application and Permit <br />11 <br />CHART NO. <br />I <br />I <br />I <br />r <br />No. 22434 DATE yl lLT <br />Service Address 5'���n'— �— Utility Account No. <br />Billing Address_ <br />City, State, Zip <br />Owner (M <br />Billing Name <br />Connection By — <br />Address <br />Phone <br />DESCRIPTION: <br />Lot -- Block <br />Dl�t <br />Unplatted Descriptio <br />T....., Per,ait• — - <br />Permit <br />Connection Charge(!. <br />Total Fee <br />Signed Customer <br />Remarks: c- <br />/— <br />�r� �i'_...K- <br />I <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved 8p <br />City Engineer - <br />'L <br />Issued By <br />I <br />Inspection By C u� <br />Date Inspected f ` <br />No. 22434 <br />