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evere� <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicatian and Permit <br />N0. �' : � i �_i DATE ,:. �l � f� <br />Scrvice Address i �� ,:i -�� �-'-- �' <br />BillingAddress_ "'�/�. y� `%� ,� <br />CitY, State, Zip__,,: �. • "f �:�� <�` �, �je, <br />Ovoner Niort a or r. ,G � <br />( 9 9 1—�G — �1`-';�_,,.r <br />Billing Name — • —%� <br />Cunnection By �':: . �i ,._, ` �u;' <br />Address //��-�'D y3�?� �% ." _ ;'; <br />Phone = �- � � ..i �> ,�, <br />DESCRIPTION: <br />Lot �� ' / �2 Block � <br />Plat _ i _ " �� ��:,7. <br />Unplatted Description <br />CHART NO,a���a ��.�� � <br />2 /�_. <br />—�� <br />Utility Account No._ <br />� �"� <br />Permit Fee �'. __ <br />Connection Charge(s�_ <br />Total Fee �il <br />::� <br />/ / <br />'_.Signed��C(.w,;/• % � w='"/ <br />� C�Womer - - <br />/ <br />SEE SKETCH ATTACHEn <br />Sewer District �� '��. <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abuttiny Lot Line <br />N, S, E, W_ <br />APProved By'..' � /. � <br />! <br />__, <br />Gry� Engineer . <br />i� <br />ji <br />ssued By '�' ' _ .—• �<__ <br />nspection By , <br />L� <br />iate Inspected�— % — 7�/ <br />:� <br />NO. <br />= �'- —��-�s---- --�-., <br />