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u <br />evcrett <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHAH 1 NU. <br />: <br />N0. 2293J DATE - �,� I <br />Service Address �� �/� i���� Utility Account No. <br />:.-� <br />Biliing Address " ' � — Permit Fee " <br />City, State, Zip ' �� �'`' � Connection Charge(s) <br />Owner (Nortgagor) � � .. Total Fee • � _ <br />Billing Name <br />Connection By �- r` <br />/ , ,� <br />Address Siyned �,,� '!� �� .%C=' � <br />Customer <br />Phone - ` �� — <br />DESCRIPTION: <br />Lo[' . ' Block / � <br />Plat v .- . / / . /- : <br />Unplatted Description <br />Tvoc Permit: . - <br />SEE SKETCH ATTACHED <br />RJSP[CT�ON <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />n <br />Hpproved [iy � /� <br />cnv enoioen � <br />/ <br />ISSUCd BV � ` � <br />Inspection B <br />Date Insoect <br />N�. 2293T <br />