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evereft <br />e <br />City of Everett <br />CHART NO. <br />/ij 0 pd =: 5 - <br />yes i� <br />/ Z/ -4'o <br />7` <br />Sewer Application and Permit <br />U� s� <br />No. 23273� �fl�ro �7 DATE <br />Service Address j�Utility Account No. <br />r— <br />�� Permit Fee 42 <br />Billing Address -- <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection By <br />Phone .2 — -2 t <br />DS�RIPTI <br />BIk / <br />plat ab= <br />Unplatted DescripCon <br />SEE SKETCH ATTACHED <br />% Connection Charge(s) <br />��FFee <br />Signed <br />Cusmmer <br />INSPECTION <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N,S,E,W, <br />Approved By '' <br />City Enjineer <br />Issued By — <br />/ <br />Inspection By <br />Date Inspected_— G <br />NO. 23273 <br />