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� <br />e �c�retl <br />� <br />City of Everett <br />Fngineering & Comrnunity Services <br />Sewer �pplication and Permit <br />DATE I % �/�_ �_ <br />n' 0. � ' i I <br />, <br />CHART NO.y���„_"�"'�_ <br />� �os j'�O <br />; /-G-TS' <br />I �-� <br />Service Address % � -•S t � _ - 4. . _ % • Ut�lity Accoi,nt No. � �� - � � <br />f Billing Address ^�� �r "��� l 1� � 1 �'� <br />-s_�. • « r. � � Permit Fee_ J _ <br />I � , <br />( Ciry, State, Zip�r.,.� ''/r�:J=> /� t%`� Connection Chargels�_ ' <br />� <br />I Owner (�Jlort a or ' . � / � . .. �� <br />� 9 9 1� -. �.:.•,��.:.,.../ �. , Total Fee_ J U __ <br />Billing Name - ' �-� <br />j Connection By �• � � . - _" � <br />--- _ �--- <br />.� � . <br />' Address� i I " i/ . Sic <br />I ��--�=-- � <br />� Phone_ ,,r' = - i j �i O <br />� — --- _------- <br />� DESCRIPTION: <br />� Lot / / Block <br />� Plat / ' ��� _� <br />, Unplatred Description_ _ <br />Type Permit: "�. % <br />Remarks: <br />---- -_ _ <br />0 <br />SEE SKETCH ATTACHED <br />iN';I'I Cfli)t: <br />2 , <br />Sewer District � / � � <br />I�Aonthly Sewer Service ` � _ <br />Monthly Sewer Constr. <br />Trunk �•�� <br />Latera <br />Abuttiny Lot Line <br />N, Sf �. W_ _ _ ;ir i <br />_- _ --ft. <br />Approved By <br />c��v E� �i���� �•� - <br />Issued By ___ _ / _ <br />i -- <br />_--, <br />h <br />Inspection By� _ <br />Datelnspected �� ��L_ ___ <br />/ <br />N0. <br />. . . ..._ a �.�:.Zr, +��a..... , .. . .. , ::� <br />