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� <br />everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and P�rmit <br />NO. �} _I �� _�_ !� DATE �'� ��l ' %/ <br />a i ���- <br />CHART NO. -�- 2"`�-S ; <br />' �� <br />/��Sr��� � <br />, �, <br />_... , <br />i <br />Service Address� Utility Account No. <br />l ��s! <br />Billing Addre�; -'/� •' ,� r� J5 /,� Permit Fee -�'� <br />u <br />City, State, Zip �^.�-� • i 1 ;%inCs Connection Charge(s) <br />.—�j _0 o,r i <br />Owner (Mortgagor) :_.-.-- • .. ' =^ 1: � Total Fee <br />Billing Name •:._._.— <br />' _.. � <br />I <br />Connection By % •` � .--�-_.- .' � <br />, � <br />Addresa >. i�� ^" � �, f �.�" /"f,.�!„'��� <br />Signed <br />� Customer , <br />' � ..t� ij i� �" . J ' <br />Phone_ ' - <br />DESCRIPTION: <br />Lot� Block ��3� <br />Plat �.._ �=� ,:1->.� <br />Unplatted Description <br />SEESKETCH ATTACHED <br />INSPf_CTIOf! <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trun <br />Abutting Lot Li�e <br />N, S, E, W, <br />.�::.:--' = �' ] �; <br />. <br />Approved By - /'/L-.r_-,� �>. _- <br />� CitV Engincer . / <br />� � -: v <br />�55�ed Bv.'.�-_.__�• <-:-s�—' _ ->, , <br />inspection By ,��/���---• <br />Date l nspected � � r"/ i7 <br />N0. <br />