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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application cnd Permit <br />n E. .; ,. _ �C� S �.� � / / <br />N0. c_ �: ,., i. �c, DATE �—�/'%1 % f'� <br />,� , � u.,�y <br />Service qddress_ "�+9-��'z � � <br />CHART NO.Lf—�S�^2g►� <br />/��S,�G=� <br />Z-�7-�� <br />��". ^ \ <br />�'� r Utility Account No. <br />Billing Address r.� � .:7 . <br />� �'- ` Permit Fee_ )_ U � <br />CitY, State, Zip '�% ��i��. �-- � <br />� f/ �a �� Connection Charge�s) `—" <br />Owner (Mortgagor�'��!-�� _ <br />'� ' �'� �'r�.Total Fee i %' �� <br />Billing Name - �— <br />Connection By___.!�_�,,. ;L <br />� — <br />Phone .7 ��� - %/� -, <br />DESCRIPTION: <br />�/;. <br />Signed_ ,sLfre.�- ��y �,f�p � �� <br />C smmer <br />Lot_______ g�ock_� Sewer District � s '%' __ ��' <br />Plat �2i-��!'c ...,��/ <br />Monthly Sewer Service �'-:��'/� <br />Unpiatted Description-= = -� • /,� .. <br />,.`"1 '� <br />_. f� r.r� � :�./E: �j� , Monthly Sewer Constr. <br />TYpe Permrt i ,.-- _ <br />SEE SKETCH ATTACHED <br />� Ii115Pi'Ci lON <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />�pproved By� „G, , . ' <br />City Enginr:.r <br />; <br />ssued Ry .��J -,% . '"''; <br />_ �,9 . . <br />ispection By � 7`� '�'- <br />3te I nspected�/ 6�7� <br />N0. , .��; C; fl <br />� <br />i <br />� <br />; <br />� <br />