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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. � � ��'. ,. DATE S �-�5 7� <br />CHART N0. " �^ "2"�n ✓ <br />� <br />� � <br />� ��.L��,;,, � � -. <br />,::��� � - <br />� <br />�: 'C_'. <br />Service Address �-`'"� O . --� : , ' . �, . . ._ - a '7 - . a u <br />Utility Account No. /I- <br />Billing Address l �U � • �-�•� '-�-- Permit Fee % ` - <br />City, State, Zip �. � vL� %i;'[�,j Connection Charge(s) ~ <br />Owner (Mort a or) " - .- � �� �� ' � <br />9 9 _ Total Fee__ i7,-_.-- �� <br />Billing f�ame <br />, -�-- F:. <br />Connection By ( � .tr. � � o � _ <br />Address �� <br />i � <br />Signed� : . -�-� . �--=,/% _s--x.� ._ . — <br />L'uitonrer <br />DESCRIPTION: Sewer District�_%'� - ____ <br />Lot � 3 Btock , <br />Plat - % .;1 � { -'i ,�. ''• --� Monthly Sewer Service _ <br />Unplatted Description _ Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />� <br />i �1�,:�r • *` _,: ,� �.���Y�.r .; ., ;-i.r.. <br />T <br />Lateral <br />Abutting Lot L.ine <br />N, S, F, W <br />Approved B� - i" + T_ <br />Ciry Enpinecr <br />� <br />�Si4Pd 8y_i',` . ���"''� __ <br />Inspection By �+ �, Q J��-r¢�__ <br />)ate Inspected J - � L - �� <br />�� <br />,; ,. / :'/ 1 1; � <br />l���", l* �f i� � A.' �.. �: �.. <br />