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e�eti' <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23005 <br />Service Address <br />Billing Address — <br />City, State, Zip <br />pwner (Mortgagor) <br />Billing Name <br />Connection By — <br />•�� <br />DESCRIPTION: <br />Block— <br />Plat <br />Unplatted Descript <br />r,,.,., o��,.,ir� <br />DATE <br />CHAFlT N0. C - i ' � `,'� `i <br />' P.�� <br />�_��_.,s <br />� <br />Utility Account No._ — <br />Permit Fee <br />Connsction Charyels) <br />Total <br />Sigfl2d Cusromer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />SEE SKETCH ATTACHED <br />INSPE�I�ION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved Ry ��1� �ngineer <br />�ssued <br />( + l.� <br />Inspection By ` <br />Datelnspected <br />G��6-%� <br />No. 230t15 <br />