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everetl <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicati�n ar�d P'ern�oit <br />No. 2244Q DATE ��'�'7 <br />CHART NO���` �`'7 <br />, • <br />�n5/ L- � <br />/— �� �- 7 % ` <br />/�"�-Q �C` <br />Service Address � "- - , Utility Account No. �" ' ' � � � �-�' � <br />�J <br />Billing Address "��%" �_ " / permit Fee J �"� <br />City, State, Zip '' �'- % ' + i Connection Charge�s) � '� �� %� -' � <br />Owner (Mortgagor) I - � r_ 'rotal �ee / `� �� <br />i <br />Billing Name — =---- �--- <br />Connection <br />,vaaress Signed <br />Cusromer <br />Phone_ , � ' %( Y <br />DESCRIPTION: <br />Lot / "�-. <br />Plat <br />Unplatted Descr <br />Sewer District � � - � �, l� <br />Block � -� <br />� :� / Monthly $ewer Service = <br />� <br />SEE SKETCH ATTACHED <br />If�1SP�CTION <br />Monthly Sewer Constr. <br />Trunk /� - � <br />Lateral '' • �'> <br />Abutting L9t Line <br />N!§,'E, W �' � • ft. <br />. �. <br />Approved By�• <br />Ciry Engincer � <br />Issued By /"' • � .- (- <br />Inspection By �� <br />Datelnspected_ �—��—%� <br />N0. ; :� I_I <br />