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CHART NO. - <br />evereH <br />e t•. <br />City of Everett <br />Sewer Application and Permit <br />No. 22854 DATE <br />Service Address__ __... _ Utility Account No. <br />Billing Address_____. _ _ Permit Fee <br />City, State, Zip _ _ Connection Charge(s)— <br />Owner (Mortgagor) Total Fee___ <br />Billing Name _ <br />Connection By <br />Address _ _. _ Signed__ _ <br />Customer <br />Phone <br />DE; CRIPTION: <br />Lot Block_.____ <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks - <br />SEE SKETCH ATTAC4ED <br />Sewer District__ <br />Monthly Sewer Service ---- <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />A pprovt d <br />City Engmeer <br />Issued <br />e. <br />Inspection B e <br />Date Inspected 3 <br />No. 22854 <br />ft. <br />INSPECTION <br />