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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Se�nrer Application and Permit <br />N0. ;? �� E� �� � �y� DATE ` �'"�/ i�; 7 — <br />� ' i _� <br />CHART Np; �- ' �� �- �' =' <br />1' <br />j�'��.. - ,J',f._� .� r ":1 �. <br />�.' <br />Service Address = ?� � � �-/'` = � ' - � ! .' �- Utility Account No. � ' � � �� �'J t' � <br />� (.: z U� . c. :. , <br />Billing Address ��— - �� Permit Fee `� <br />c _; <br />City, State, Zip 'tt2� E 1Jl�l-_ �'1 i D�% L� Connection Charge�s) -' �� <br />Owner (Mortgagor� F f I C (, ;.,: �� ;,; nt-.1 '[_3 c.d•..'Fota�Fee <br />Billing Name <br />Connection <br />�. � <br />, ';' !��[ C_-� <br />Address �� �% �� � i i -s <br />r <br />Phone - ''>� '� <br />DESCR I PTI ON: <br />Lot _ " % � <br />Plat ��� � <br />Unplatted Descripti� <br />� Type Permit: <br />Remarks: <br />Block_ <br />i ���t c�� <br />SEE SKETCH ATTACHE <br />iP��:�...�..: <br />�%'��� � �7. <br />Signed� � �1l.-.'7! � /l�e�utAe�. <br />Customer <br />Sewer District - � � ' '-' -' U <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Trunk <br />Lateral! <br />Abutting Lot Line <br />N, S, E, W_ <br />�z ,-� <br />� �_ <br />ApprovedBy � i�t. �-''Jrn.r�r <br />Ciry Engineer <br />Issued By-� � - -7 <br />Inspection By ������' 2-G4.-� _ <br />Datelnspected _ �j���! % <br />N0. ' <br />�� m"if�R � �� �'s� t •,-'": <br />1�S`` G.�f.. <br />