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I <br />everetl <br />e <br />City of Everett <br />Engineering & Community .`,ervices <br />Sewer Application and Permit <br />N0. 22422 DATE <br />Service Address <br />Billing Address -'� ;u <br />City, State, Zip _ <br />Owner (Mortgagor) J <br />CHART NO.^8+�—`�— <br />Utility Account No. " <br />Permit Fee d <br />Connection Charges) <br />Total Fee 4, <br />Billing Name <br />Connection By <br />Address Signed inns x 1' ` - <br />customer <br />DESCRIPTION <br />Lot Block <br />Plat <br />Unplatted Description - — -- — <br />Type Permit: <br />Remarks: <br />Sewer District - <br />Monthly Sewer Service U <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />----- _ — Approved By — <br />_ City Engineer i <br />— — --- — '— Issued By — <br />SEE SKETCH ATTACHED <br />Inspection By Ka C" <br />Date Inspected <. 7 7( 5� <br />NO. c;''4 1 <br />