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� <br />evereit <br />� <br />City of Everett <br />Sewer Ap�slication and Permit <br />"0 22g09 <br />DATE <br />, Service Address . <br />� ------- .__-= �, � t--- <br />Billing qddress __ � . <br />, � � ; � � <br />I _ <br />' CitY, State, Zip�_ �-.:�.1'I� � � i..0 <br />Owner (Mortgagor� / �� �, , , � � `— <br />' l- _ <br />Billing Name � / � , , , i. <br />�. <br />Utility Account <br />Perrnit Fee <br />ICHART NO. i,' ?- � f-.i __ _- <br />, �L <br />� -; �y <br />�� <br />I <br />` i Ll <br />C.'• <br />(.unnecrion Charge�s) '�— <br />T�tal Fee , � , ! i <br />ConnectionpY-/ / �_ i i �, �- <br />, , , ----- • <br />Address ' ' <br />__�-=��k. � -.' � . .. / .. <br />-Signed_ <br />Phone_=----- —�- - �-� - <br />Cuslomer <br />DESCRIPTION: <br />Loi._� _ Block�__ <br />Plat 1�. i- E i -� <br />Unplatted Descnp �/ , <br />TYPe Permit: ' /�. . r,' <br />; -----C'-''.%^. tc. i i <br />� /__. <br />Remarks: — ----- <br />SEE SKETCH ATTACHED <br />J <br />Sewer Districl�_/ / ���� T <br />Monthly Sewer Se.vice � �- �•' <br />__ Mnnthly Sewer Cu�str. <br />Trunk �� � 1- �.� <br />La[eral ��• - ' C <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By ( f ���---- � , `� � _ <br />- CtlY Enp.��cer <br />Issued By � _ r - � � ; / <br />� �c/ <br />Inspection g �/r ��/�,� � <br />� - - �.L.�/�-v`ar l <br />D�te Inspected � `%-�� <br />"0 22g09 <br />