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everett <br />Le <br />City of Everett <br />Sewer Application and Permit <br />No. 23190 DATE <br />CHART NO. <br />Q E.-s- <br />7 <br />7-1�i-7H <br />arz <br />Service Address---- . 7-.- -- <br />— Utility Account No <br />Billing Address_ --_ ___ _— — <br />_ Permit Fee <br />City, State, Zip _ <br />Connection Charge <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By <br />Address <br />_ Signed <br />DESCRIPTION: Sewer District <br />Lot Block <br />Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: Trunk / <br />Lateral <br />nemarKS: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, IN ft. <br />Approved By <br />City Engineer <br />Issued B <br />Inspection By /' <br />Date Inspected V / 7 <br />No. 23190 <br />