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- ..-. . <br /> everen , cHARr rvo.�/�- � % - `� <br /> .� : , 7 -���s - y <br /> e� - . <br /> I �� � ;�� � <br /> City of Everett / � � <br /> 8ngineering & Community Services ,��/ � <br /> Sewer Application and Permit ; � � = <br /> N0. , ' `' , A.'. `L DATE ' _ � <br /> Service Address �"�`"" � � � Utility Account No.�• 3�- 3 `�-: ��� <br /> Billing Address � � / - ..�,�. T �V �� <br /> Permit Fee <br /> � 5 <br /> City, State, 2ip_ � '..: . • � ' � '� Connection Charge�s�_ YI� <br /> � �� <br /> Owner (Mortgagor) _ Total Fee__ V <br /> . .f ------ --- -------- <br /> Billing Name � ' �.. — v • <br /> Connection By `--� <br /> — � <br /> Address _ Siyned �;��- <br /> �� �� ,�� ,{f . <br /> Phone �r� _ �� r� Cus�omer — <br /> DESCRIPTION: Sewer District�� _.�',� ,/ � <br /> Lot � Block___._ --- — <br /> Plat _ � Monthly Sewer Service -- 7: . %� , ! <br /> Unplatted Descridtion_ •—�� Monthly Sewer Constr. <br /> Type Permit: '�-� .� i 'F �' — Trunk `7� U�( ���,y� <br /> �, <br /> ` � _ , ,� i�� ` � _ Lateral_ r0 } 5/,YO. c�N <br /> Remarks: — <br /> Ahutting Lo� Linc <br /> - _ _ N, `;, E, lV %� �'�� __--f�. <br /> Approved 13y � <br /> — o�v E�;�i;� ,� - - - --- -- <br /> Issued By r ' _'" ;' <br /> — <br /> i , <br /> -_ ------- Inspection By � ,,( 1i-f'/7��� <br /> -- — ------- - <br /> -� �7 <br /> p---.__ _. _ _ Date Inspected_ Q � cJ O -- / <br /> SEE SKETCH ATT�ICHED NO. <br /> , <br />