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everett <br />.� <br />City of Everett <br />Sewer Application and Permit <br />NO. ZJ1O6 DAT[ _�'—� � -a- <br />CHART NO.—� � Z �' �� <br />Service Address `<< � t' j- �--`�` 4. L. � l' i�-� Utility Account No._ <br />! <br />Billing Address ' ' � � � � '" �� '" �-- ' �" r`� permit Fee <br />City, State, Zip �--��'= w--C_l'S' ����:'' '` �--�- __; Connection Chargelsl_ <br />Owner (Mortgagor) � ,_ . 1"' , . ; ' '- " � ': : !--.<. � •'. i'Iotal Fee_--- � <br />Billing Name � ' i � ' C- �_ ,-'-. 7 .... <br />Connection By ' }: _ � , ', �_�_ �! _ !� - � ' ; �- <br />,' " , <br />Address ' f 11 (. �.•��...;. �_ � L. :_f_ Signed ---- <br />c��s�o�„�� <br />Phone_---= .-E ,� . ; � _ . <br />i <br />Sewer District_ �_ <br />DESCRIPTION: <br />Lot Block `"' <br />{_� �i, ,�. ,�—_ -`._ <br />Plat - - <br />Unplatted Description_ -- <br />Type Permit: '. ( <br />Remarks: <br />E[E SKETCH ATT�:CHED <br />Mon[hly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral _ <br />..;�. I'i�:.11U:.- <br />Abuttiny Lot Line <br />��- S• E� W----- <br />� i j ' <br />Approvec: By ' ' ` ' <br />Ciry Engmccr <br />� � �, �.._. . � i. <br />Issued E3V �' - — <br />�� <br />'' G��a.� <br />Inspec[ion By_ ��� <br />/�-Date Insp��cted___ b '� � <br />No. 231Q6 <br />