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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer �pplication and Permit <br />NO. � � � .� DATE �� ��% � �� <br />CHART NO.���pa <br />! ��i S � �..� � <br />�- � 3" �' � <br />; i �,� <br />� <br />Service Address � ��� � \ �' ' "�! _' • _ � Utility Accaunt No. <br />� <br />City, State, <br />Owner (Mortgagor) <br />Billing Name <br />i '.i- C. -�-- <br />Connection By � -/- �' =� � <br />/,. <br />Addre�s / (% <br />DESCRIPTION: <br />Permit Fee '> ' -" ' <br />Connection Charge�s)_ <br />Total Fee � <br />� � -;' /% <br />Signed �_.<": '`' c �� ,' �,� r"�'=�` =`Y <br />Cusmmer <br />S�WCf �l <br />Lot �� — �� Block � <br />.� J c l"r � r .,�� Monthly Sewer Service. <br />Plat - <br />Unplatted Description __ Monthly Sewer Constr. <br />Type Permit: <br />SEESKETCH ATTACHED <br />_. � f �.c' . ? _�_'� .. __ • ^,� , _ - <br />Lateral <br />Abutting Lot Line <br />PJ, S, E, VJ <br />Approved By � _ <br />City Engineer ��/ <br />i. '. � i <br />�55UBd Qy , <br />� <br />,�, % �;�_ <br />, <br />Inspection By�" r�'`J'�'�`''� <br />Date I nspected �-�`� 7 0 <br />N O. _� �; - �- <br />INSPLCTION • <br />� �. <br />. . _ �f �°. , . .. ...� _¢_, u. __. _ .. <br />