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everett <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Perr�it <br />NO. � n� i i;) DATE '%/! '' � <br />� -�, _ _ r-.,... � <br />CHART N0. �"'� '�"•�' �� � <br />i <br />/�� ; <br />j, . ':�� ; <br />j 3.S' �': ; <br />Service Address �" " � �` 'r ` �; Utility Account No. <br />Billing Address '�� L"" "� Permit Fee <br />City, State, Zip '•� !`!-� -: ' Connection Charge� <br />;a <br />� , _ <br />Owner (Mortgagor) ��--' - (: -' � � "Total Fae <br />� <br />, <br />Billing Name %`�'' "'-� <br />._� �' -�� "�/� <br />(� , <br />�— <br />- .' � <br />Connection By /� ,�-'��'y" , �� � � �`J �! , , �. <br />� � . ' , <br />�.� . . ; `�i,' ` gigned '� :L� ,' ,, '�� <br />p,C�dfBSS - Customcr <br />; i ;L <br />Phone �7 %' '- '� `� J / <br />CESCRIPTION: <br />Lot_'� ' = � ��Block <br />Plat _ �' - �' <br />Unplatted Description <br />Tvpe Permit: <br />❑ <br />SEE SKETCH ATTACHED <br />''"'�-,'_ . _ '-"'"�� <br />!�� � - _.._.-�.. ..___.'___�. _ _— . —__'___ <br />6 <br />a <br />Sewer District , <br />Monthly Sewer Service '` - <br />i <br />Monthly Sewer Constr. <br />,I <br />Trunk <br />Lateral i <br />Abutting Lot Line ' <br />N, S, E, W ft. � <br />I <br />; <br />i <br />� , i <br />Approved By � � I <br />City Engineer i <br />/ I <br />I SSU CCJ <br />/ <br />v/� —) <br />Inspection By , � �'r� <br />Date Inspecteo_ l � /�-�� <br />, <br />NO. _ ,_ I <br />iivs���c�nor� � <br />� �-��.�,H!.'. },•', ." pre : � i: S "2`-�:_:�.,-: <br />� r. � <br />