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eD <br />City of Everett <br />Sewer Application and Permit <br />No. 22884 <br />3421 <br />Service Address, <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor)_ -- <br />Billing Name <br />Connection By <br />Address_ <br />Phone <br />DESCRIPTION: <br />Lot Bi- <br />Plat <br />Unplatted Description <br />Type Permit: <br />DATE _ <br />SEE SKETCH ATTACHED <br />CHART NO. ISO -29-�� <br />r' <br />Utility Account No <br />Permit Fee. <br />Connection Charge <br />Total Fee__ <br />Signed <br />Customer <br />INSPECTION <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 By <br />ury engineer <br />Issued By <br />Inspe,:tion By '(W �4 <br />Date I nsoected <br />No. 22884 <br />