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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />i� -. ���' <br />Sew�r Application and Permit <br />NO. �2[���'? DATE �' ��� 7Y� <br />CHART NG.�'Y� / � �- - • - �/ <br />�E��. <br />�-a���9 <br />� <br />�., <br />Service Address ���U i::. Utility Account No. s• � F- j� �_�� <br />�5 /� � , i-�� 3/ <br />Billing Address - � r Permit Fee �U <br />� ,:���' � <br />CitY, State, Ziry' �...� f� ,-;!l�. . %x��'G c" `�""" - <br />' / , -� Connection Charge(s�_�-•+ .1,� <br />� , <br />Owner(Mortgagorl%'%:- �r� >..� _ :._.� - .;:i� .` �U � <br />— ��-Total Fee <br />_ � <br />Billing Name - ' .�= :� -: � : ->;✓ <br />Connection Bv -:' � �� <br />Phone � =' J - ,.=� � � � <br />DFSCRIPTION: <br />Lot Block_ <br />Plat <br />�- <br />�, <br />i <br />' ��� ,-' -, <br />Signed/ - <br />% Customer <br />Sewer District j� . 1 r //i <br />Monthly Sewer Service �'�/ <br />Unplatted Description . � i �!�� �%� / , - -- r' - =i <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />° ` "� � <br />w '�s�. ..QrY� 1 Y.-�f .' � <br />r�illl' t"� ezl. _ <br />�� <br />Trunk � • UU �� ;�� <br />Lateral �• %�!% �D�, � <br />Abutting Lot�`J,e� <br />N, S��°° ` �� ft. <br />�__ i/-� , <br />4PP�oved By\' /,�.c.-, :. , :. . <br />' Cuv Engmeer � � <br />�" 1 r'� <br />ssued By /} _ � � <br />nsper.tion B G <br />�ate I nspected � �- 2� <br />„ c • <br />� t Y ti �.i ,'_'�5 � 6,1i:: <br />\ <br />u <br />