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everett <br />e <br />City of Everett <br />Sewer Applicc�tion and P�rmit <br />CHART NO. - <br />y-�d.s % r=� <br />y-z� •� 7 <br />�� <br />No. 23024 DATE _ � i <br />Service Address �� � Utility Account No. I <br />Billing Address Permif Fee I <br />City, State, Zip Connection Chargels) � <br />Owner (Mortgagor) Total Fee -- i <br />Billing Name <br />Connection By — � I <br />. .', , <br />! r%� �� � � � <br />Address Signed c�:�om�� <br />Phone <br />DESCRIPTION: Sewer District — <br />' Lot Block Monthly Sewer Service — ' <br />Plat — I <br />Unplatted Description Monthly Sewer Constr. i <br />� <br />Trunk <br />SEESKETCH ATTACHED <br />;I I�. I-I ' i I�'�l <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved 8y � <br />Cily Engmeer - <br />I SSU Cd <br />' ! � ,� i� c � . r i�7"� <br />Inspectian By— <br />Date Insper.ted " " % � — <br />No. 23024 <br />I <br />