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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�alication and Permit <br />CHART N0. '', �J ` .� � �' <br />�=os%�'-� �� <br />N0. �' 1 1°,: 3 DATE % �% l I <br />Service Address � � � jJ ''� ^' , �� /1 (� r Utility Account No. � - -� ' � r'7� - C� f _ <br />,� <br />Billing Address `�� � ��' � 7� =�'%` Permit Fee � 0 � <br />Ciry, State, Zip � �M �'N !' � :l`�1. %i0_ D Connection Charge(s) -="LZ • '� %�t%.��/� <br />Owner (Mortgagor) /�'� � - i��f � L� iy �' �• i %� / Total Fee ='L' ' � ��� <br />Billing Name �� �� � <br />� <br />Connection By /1 r? J� :� �� i _. � . ,' . '!� ; �� % <br />Address_%`'�/ /N�:/�/ L 9��D �'��1'� Si ned /�' --�• � <br />/� �i !: i i j r .; / . . %_; 9 cu:i ,. <br />Phone ' /� <br />DESCRIPTION: SewerDistrict =`� f--�'•'-'�� <br />Lot � � Block l <br />f yF . ;,; MonthlySewerService ���Lrt-��-Clr� <br />Plat!-� '��, i-r r� j i�.. �� <br />Unplatted Description 0��' w� Monthly Sewer Constr. <br />I• SEE SKETCH laTTACH <br />` <br />I f �! 54'ECTIC?i ' <br />Trunk . % =� <br />Lateral i�.e-• J' <br />Abutting Lot_Line <br />N, S`E; W � z-' S ft. <br />Approved By � /��f �� N / N (-. <br />Gry EngineM <br />Issued By / -" - - � _ <br />Inspection By����C�'�-� <br />Datelnspected 7 � -• _.. <br />N0. <br />