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CHART N0. J /' <br />/ <br />Lerett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />DATE <br />N0. r2.�1 i <br />':nF <br />D, 3l/-0/ <br />%Sd� ,� � _ � ,;„L_; Account No. <br />Service Address � J E <br />• �• , .,:,,,, Permit Fee �I <br />Billing Address 7 <br />Connection Charge(s) <br />State, "Lip --�� <br />City, <br />Total Fee <br />Owner (Mortgagor) / • "�• • <br />Billing Name <br />Connection BY <br />r _ /1) <br />079 <br />DESCRIPTION: <br />Lot s B/lock� <br />Plat <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />Signed_ <br />tISPCCTIO'. <br />Sewer District t'^ %. / <br />Monthly Sewer Service l <br />Monthly Sewer Constr. <br />Lateral <br />1 • /0 <br />kbutting Lott ne / ft. <br />N, S! ' w <br />approved By, <br />city Engineer fffyyyIII� <br />Issued BY n —' <br />Inspection B <br />DateInspected <br />J.� <br />f -7 <br />NO. <br />