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i <br />Eevereft <br />- <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22443 DATE ( ! <br />Service Address <br />Billing Address U�" `/U JX <br />City. State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By — <br />Address <br />Phone <br />DESCRIPTION: <br />CHART NO. <br />Utility Account No. <br />Permit Fee — <br />Connection Charge(s) <br />O� <br />Total Fee / O 0 <br />Signed y <br />C usmmer <br />Sewer District <br />` Block <br />Lot �—"� � � .. Monthly Sewer Service <br />Plat �! - %-.c. - <br />Monthly Sewer Constr. <br />Unplatted Description_ <br />Trunk <br />(lam <br />Lateral /(• y / 7, <br />SEE SKETCH ATTACHED INSP�a: l it <br />Abuttin}jq jot Line ft. <br />LNI S, E, W <br />Approved'By <br />otv Engmeer <br />Issued By <br />Inspection By <br />Dale Inspected_—// J O - Z2 <br />RX <br />