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�/p �YOV S �'' <br />/o- 3��� <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. (.L u i� DATE ____,�� f-�7� <br />CHART N0, -2-Z��-Lf _ , <br />-r— <br />�a, : ��> � �, ` <br />Service Address Ci` �� 3� .Y'"��--, - :� �,. � F� Utility Account No. <br />_ ' �� <br />Billing Address Permit Fee .-� , <br />City, State, Zip <br />.� <br />Owner (Mortgagar) �-,Z r „ �!�. r' _ �•�/ <br />Billing Name `- � •��• / <br />Connection By - �_� <br />Address ' �. �. -� �/`�l �— <br />Phone > � '� - /� j 5� <br />DESCRIPTION: <br />Lot B lock <br />;:LL <br />Connect�on Charge(s) <br />� �� <br />Total Fee_ _ <br />i,-'7 -; '�� <br />1) � � � I <br />Signed V;' :..v' � -';�, l.. '''� <br />�'� Customer � <br />Se�.ver <br />Plat Monthly Sewer.,_....,_, <br />�� �,�. / <br />Unplatted Description J /� • C. / Monthly Sewer Constr. <br />_ `./ . � 1:,:� <br />Type Pe��nit: (�,� -:� _ r;.� <br />' G <br />Hemarks: � <br />�/ , <br />--�-r— <br />2�3��� ��oN f���� <br />SEESKETCH ATTACHFD� <br />� �,� Ii�iL'P� 0"f!OfJ <br />Trunk._ <br />Lateral_ <br />Abuttiug Lot Line <br />N, S, E, W. <br />Approved By, �- �,/ • <br />Ciry Engincer r�� <br />Issued By' / <br />T <br />Inspection By � !� .-�-� � �---> <br />Date Inspected ��� <br />N O. ': � �': -. <br />