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e•,,� rett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23208 <br />DATE T�7L� � <br />Service Address l � <br />Billing Address - <br />City, State, Zip ' �' � <br />Owner (Mortgagor) <br />Billing Name <br />Co�nection <br />Address <br />_ - i <br />� <br />CHART NO.�; � 3- Z C�/ <br />i� <br />�-�4 �� <br />�e�-. <br />Utility Account No. ,/ 5 0`�6 <br />' . __� <br />Permit Fee <br />„`--_ <br />Connection Charge�s) % `� � <br />i - <br />% Total Fee � � ' <br />Signed <br />Customer <br />DESCRIPTION: Sewer District � �-� <br />Lot y Block � � - ,� <br />— Monthly Sewer Service <br />Plat - <br />Unplatted Description E� — Monthly Sewer Constr. <br />Tvr� Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk � / ' <br />Lateral <br />Abutting Lot Line <br />N, g, E, W ft. <br />Approved By '� ✓ <br />City Engineer <br />ISSUCfI By_' <br />Inspection By `�'� <br />Date Inspected / '- l7 '� / � � <br />No. 2320A <br />� <br />