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everett <br />� <br />9 <br />l ' <br />I <br />� <br />City of Everett �' (,� �' C/ <br />:, q_;"s- ' l7_�i�l <br />�:/, '/ �� � � . <br />�e�nre� �4pplication anc� P�rmit <br />No. 23188 <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner �Mortgagor) <br />E3illing Name <br />Conner.[ion By <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descri <br />� T,�..o Pormit� <br />Block <br />DATE <br />CHART N <br />_ _ Utility Account No. <br />� ;' __ Permit Fee <br />_ Connection Charge(s) — <br />Tot,d Fu� - _ _ _ __ <br />i <br />�ic;ncd <br />SEE SKETCH ATTACHED <br />� <br />Cus�onu•, � -- - --- <br />Sewer District __ __ ------- -- <br />Monthly Sewer Service___ _ __ _ _ _ _ <br />Monthly Sewer Constr. <br />Trunk_ ____ __ _ __-- <br />Lateral __ ____ <br />Abutting Lot Line <br />N, S, E, W— -- – ft <br />Approved By — <br />Ciry En�incer <br />ISSUCCJ B <br />Inspection By — �?�' � " ��� <br />Date I nspected U ✓, � <br />rvo. 231£�8 <br />