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a <br />CHART NO. LA <br />everetl <br />City of Everett <br />Sewer Application and Permit <br />No. 23171 �D/ATE / I J I— ----- <br />Service Address U ��7h iA-7// - Utility Account No. <br />Billing Address Permit Fee <br />City, State, Zip Q Connection Charge(s)__-___- <br />Owner (Mortgagor) - Total Fee <br />Billing Name <br />Connection <br />i <br />Address Signed_ <��`•i <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block <br />Plat Monthly Sewer Service _ <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N S, E W �' <br />Approved By - _ <br />City Engineer <br />Issued <br />Inspection By,:��+^ <br />Date Inspected_ V/ — <br />NO, 23171 <br />