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evere" <br />�e <br />City of Everett <br />CHART NO. FAS'ZB_S <br />Pam( <br />Sewer Application and Permit <br />No. 23161 <br />Service <br />DATE <br />- � t <br />Utility Account No <br />Billing Address [ I ti I <br />City, State, Zip 1 � % , , , , kt I, <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />A <br />Phone <br />DESCRIPTION: <br />Lot_ Block --- <br />Plat <br />Unplatted Description ---- <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Permit Fee <br />Connection Charge(s) 1 <br />Total Fee_ _ <br />Signed <br />Customer <br />Sewer District L.1Z <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By ,L <br />Date Inspected h ' / Z' 75 <br />No. 23161 <br />INSPECT ION <br />