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CHART NO. <br />everett <br />�e <br />City of Everett <br />Sewer Application and Permit <br />No. 23160 DAU 1--11 1 L <br />Service Address_____ -- - - — — Utility Account No. <br />Billing Address <br />City, State, <br />Permit Fee <br />Connection Charge(s) t <br />Owner (Mortgagor) Total Fee <br />Billing Nam <br />Connection <br />Address- <br />Phone — <br />DESCRIPTION: <br />Lot I Block --- <br />Plat \� r, . ' t . , . t t <br />Unplatted Description_ — <br />Type Permit: <br />Remarks: <br />DK To COi1�/� <br />SEE SKETCH ATTACHEC <br />r <br />Signed <br />custotm-r <br />Sewer District TEL <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By I i I <br />City Engineer <br />Issued <br />Inspection By <br />Date Inspected L ' IF a. 719 <br />NO. 23160 <br />INSPf CI1ON <br />