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everett <br />e <br />City of Everett <br />' Engineering & Community Service; <br />Sewer Application and Permit <br />NO. � � li �! � DAT� �{Y- ..; S- 7 1 ` � <br />- � ' <br />Service Address --� J/ �-'���� ��i -� - � p.(9-Q�itility Account I <br />Billing Address <br />City, State, Zip <br />/�.�c�, <br />CHART NO..*�/ `l.` � ` - <br />�5� �� <br />� z z -7j <br />Permit Fee " -�_� ; <br />Connection <br />Ownei (Mortgagor) Total <br />Billing Name <br />�. ..- .,— �--�' <br />Connection By_�'�; ' _ L/ <br />Address_ /��, <br />DESCRIPTION: <br />Lot <br />PIaL <br />Unplatted Descr <br />Block <br />Type Permit: ,-.�,.. : � _ <br />Signed_ __ - �� �� _ � .i �---;'- ,� _ .�-. <br />C�smmer <br />Sewer Disrrict / <br />SEE SKETCH ATTACHED <br />i li�!:�PECTI�`I; <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, W. <br />Approved Ba� � � � � - <br />Ciry Engineer � <br />Issued By � " � <br />,: <br />Inspection By ' ' '� <br />Jate Inspected ` � `%-� <br />N0. . . <br />i <br />tl <br />