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i <br /> everett _ I �HART N0. ' <br /> i <br /> e � : <br /> City of Everett � <br /> Enpineering & Community Services � <br /> I <br /> Sewer Application and Permit { <br /> ' N0. 2 2 7 6 7 DATE � � '�. / �l � I <br /> � i <br /> Service Address r- ��� � Utility Account No. ! <br /> ,:,,r . ;"� I . ... <br /> Billing Address . � �-'"' y �� Permit Fee v i <br /> _ � <br /> City,State, Zip . ��� �� - / - �;- Connection Charge�s) l� i <br /> Owner (Mortgagor) � • - Total Fee l <br /> Billing Name �.--- j <br /> ' Connection By - <br /> , ;• . <br /> Address _ Siyned <br /> cusrome� <br /> Phone- - ' _ ' J ,- . <br /> DESCRIPTIQN: Sewer District <br /> Lot �� Block � ` � � <br /> Plat - Monthly Sewer Service <br /> i <br /> Unplatted Description _ Monthly Sewer Constr. � <br /> Type Permit: � , - Trunk I <br /> — � ' , <br /> Lateral '' <br /> Remarks: <br /> Abutting Lot Linr, �'� <br /> N, S, E, W ft. ; <br /> � <br /> � <br /> i <br /> I <br /> Approved B�y � <br /> City Enqineer <br /> � .� {' . . , � - <br /> Issued By ^ ' —1'"" <br /> � <br /> Inspection By <br /> Date I nspected <br /> , SEE SKETCH ATTACHED N0. �Z27G7 <br /> INSPECTION � <br />