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everett <br />,,e <br />City of Everett <br />CHART NO. X <br />E'S <br />P&5z�I <br />7- 23-' j <br />Sewer Application and Permit <br />No. 23090 <br />DATE <br />Service Address C,q,- 7 ✓� ��� - J� Utility Account No <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name__ <br />Connection <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Permit <br />Connection Charge(s) <br />Total <br />Signed <br />Customer <br />Sewer <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engineer j <br />I ssuea <br />Inspection By ^�.7./0/ — <br />Date Inspected S �G / I <br />No. 23090 <br />INSPECTION <br />