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everett <br />�.e <br />City of Everett <br />Sewer Application and Permit <br />No. 23513 DATE <br />Service Address - <br />Billing Address��� <br />CHART NO. <br />FOSi C- Q -7 - 21-8o <br />Utility Account No.44S 'may— <br />Permit Fee / 7- - <br />City, State, Zip Connection Charge(s) , O �1 3 <br />d � <br />Owner (Mortgago ) Totaf`Fee / 2'-42 <br />Billing Name <br />Connection By— <br />Address— <br />Phone — <br />DESCRIPTION: <br />Lot <br />Plat <br />i <br />Signed <br />Customer <br />Sewer District_ <br />Monthly Sewer Service <br />Unplatted Description5'% /,/ * 17- z..f -5' Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk g `7 , <br />Lateral // 9 2 <br />Abutting Lot Line <br />•N, S, E, W. <br />Approved By <br />City Engineer �_ / <br />Issued By <br />Inspect' <br />Date Inspected b �� <br />No. 23513 <br />C,_ <br />