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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />rvo. 231�E <br />Service Address <br />Billing Address <br />Ciry, State, Zip <br />Owner (Mortgagor) <br />Billin9 Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot _ Block_ <br />Plat <br />Unplatted Description. <br />Type Permit: <br />DATE <br />CHART N0. �'� �� � ' � <br />f ��s j �_� <br />�-�-�f <br />l ��� <br />Utility Account No. <br />Permit Fee_— <br />Connection Charye� <br />Total <br />Signed — <br />Cuslomer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />IN:iPE��lI(�I: <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />� <br />Approved By <br />City Engineer <br />ISSUe[J By I <br />� I <br />/�— � I <br />Inspectio� By ��y� �`�� ! <br />��/ <br />Date Inspected J JO '"�/" I <br />rvo. 23136 �, <br />