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� <br />everett <br />� <br />City of Everett <br />Enyineering & Community Services <br />Sewer Appiiccafion and Permit <br />NO. _._. ; � DATE <br />, - <br />Service Address " �� <br />Billing Address ' '? !�%.� X � ` i ' <br />CitY, State, 7_ip '=+� .=` � "rr'fS •�! `/ :;' �=L <br />Owner (Mortgagor) �li r r�, � j� r."',��r c'o.;i� <br />Billing Name � y- ' r <br />Connection Bv '� � %�� ' � '� � <br />9 <br />Address �� ���� K / = � � <br />OL.nno " �/ ' . � ��'� �" — <br />DESCRIPTION: . <br />Lot�Y � ��� Block ���k I <br />� <br />Plat _ <br />Unplatted Description <br />Type Permit: <br />CHNRT IV0.1�L�`�=�I - <br />/ <br />o� 3 ,i G� %-� <br />�` Z�'' � �' <br />� ���� <br />Uti�ity Account N <br />Permit Fee <br />Connection Charge( <br />r�ri!�: <br />= � <br />Signed�;._`�f�,Jjr� � ,_____'i��r�.�.: <br />�r „ Cusromer � -{i <br />SEE SKETCH ATTACHED <br />'.,,�.I" �" I�. , <br />.,n• . <br />�� � . . � . .. . . � . . . <br />Sewer D <br />Monthly Sewer Service — <br />Monthl�� Sewer Constr. <br />Lateral_ <br />Abutting Lot Line <br />N,S,E,W <br />APProved By ` � > ';,�'� <br />Cily Engineer . <br />� Yt/ . <br />Issued By �d'. �� '�"�''"-� <br />Inspection By ��tiC —�"��'c� <br />Uatelnspected a �/�� <br />NO. � • <br />