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a <br /> CHART NO. <br /> everett <br /> i <br /> 1 ' IbSTEp <br /> City of Everett <br /> Lit • <br /> Sewer Application and Permit <br /> No, 23858 DATE Z / <br /> Service Address �(� I�' ,�• Utility Account No. ff- V <br /> Billing Address—/ Permit Fee -i' <br /> City, State, Zip_ r / �— r' `/ Connection Charge(s) i/D <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> . ;Customer <br /> l <br /> Phone_ - • <br /> DESCRIPTION: Sewer District_ <br /> Lot / Block <br /> Plat 1 Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: _ Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W <br /> - Approved By <br /> I <br /> City Engineer / <br /> Issued By <br /> Inspectio <br /> Date Inspected C:;I` <br /> SEE SKETCH ATTACHED No. 23858 <br /> i <br /> INSPECTION <br />