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everett <br />e <br />City of Everett <br />CHART NO._ <br />c�i-�;�—z�-y <br />Sewer Application and Permit <br />No. ��333 <br />Service Flddress � ' � �•� �"j <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Description <br />DATE <br />"- Utility Accoun[ No. <br />— Permit Fe� <br />_ Connection Charge� <br />— Total Fee <br />Siyned <br />:_�;�,- <br />/� � y _ -. , <br />cuvoincr <br />Sewer District <br />Block <br />Monthly Sewer Service. <br />_ Monthly Sewer Constr. <br />Type Permit: ., _ _ <br />SEE SKETCH ATTACFiED <br />INSPECTION <br />Lateral <br />butting Lot Line <br />N, S. E. W <br />pproved By <br />City Engincer <br />SUECJ <br />i / r <br />spection8y l)/�� J:/�:.ic�( <br />ite I nspected /� - i :�=1�� <br />No. 23333 <br />