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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No.23203 DATE <br />Service F,ddress <br />Billing Address — <br />City, State, Zip_ � <br />Owner �Mortgagor) ' <br />Billing Name <br />Connection By <br />Address <br />Phone % <br />DESCRIPTION: <br />Lot Block <br />Plat � <br />Unplatted Description <br />Type Permit: <br />CHART NO. �- ���' 71-5 <br />Utility Accou�t No. <br />Permit Fee <br />Connection Chargel <br />Total Fee <br />;� _ � � y�,r, � =;, <br />.kt ; <br />f <br />Signed <br />c�:�om�� <br />SEE SKETCFI ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ci�y Engincei <br />I ssu ed <br />Inspection <br />Datelnspe <br />No. 23203 <br />