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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />CHART NO. �' 3U - V'9- i"� <br />r�asL'c'� , <br />�--��.�� .. <br />�� <br />Sew�r Application and Permit <br />N0. .' �' r' ; �, DATE ,��%�7.�'� <br />� IvCS ��9�L <br />Service Address --a� � <br />Billing Address > y�� �-.<—� - / /��r- �:.� <br />; � _ <br />CitY, State, Zip r-. �_. ; / ;7� . %i .� .�1 � <br />Owner (Mortgagor) l �.� .-/ ,� <br />Billing Na <br />Utility Account <br />n `';.- <br />Permit Fee— jn � <br />Connection Charge(s) '"'""'� <br />Total Fee_ j� u1� <br />Connection By _ _ , � <br />t � <br />Address— Signed_ r1 /�ci�',.�_,_. �i��� {..t--, ...-a---:-� <br />�.. / _ ,� �D Cus[omer <br />Phone ' <br />DESCRIPTION: Sewer District <br />Lot �y Block� <br />Plat _ � � . ' ' Monthly Sewer Service � � SO <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />t;�� � � <br />k <br />�Tj,4tii�p�_i.c.:.'•;�a.�R� �-. %7., iA��"',,:3�� � .''. <br />r••. <br />i <br />Abutting Lot Line _,� <br />N. S, E, W :7/<: -.; ., _. -.� ft. <br />� ' l <br />� _ / / <br />Approved By--� " ,:l-,... <br />City Enpineer <br />� " ? �' <br />Issued By / -. . � <br />Inspection B <br />�/ <br />)ate Inspected ��� Z �' ��_ <br />• <br />� . ,.•+. r�+ 'k.,r , . <br />" c <br />