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everett <br />1 <br />City of Everett <br />CHART NO. <br />yea s i FD <br />y �zo' 27 <br />4-9 <br />Sewer Application and Permit <br />No. 23018 DATE <br />Service Address <br />Billing Address — <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By J <br />Aririrecc <br />DESCRiPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: , <br />Block <br />Remarks: <br />n <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee__ <br />Signed is �- <br />Customer <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By <br />Date Inspected_ <br />No. 23018 <br />