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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />B <br />i <br />Sewer Application and Permit <br />NO. =' % j_ � � �' DATE <br />CHART NO. �/'� � Z9 � S <br />�� s TLrO <br />,o _ �_ ? � <br />��� <br />Service Address ^� �' � �� ��� ' --� •Utility Account N <br />Billing <br />City, State, Zip <br />Permit <br />Connection Charge(s) ---�-"""`— <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />. ; <br />r' <br />� �-� ;-'f'._ <br />Connection By �-- ' - <br />1� . �., <br />DESCRIPTION: <br />Lot �"` �" � � Block '2 <br />Plat. -' -' ._ - . C� ��-f' <br />Unplatted Descriptio�i <br />Type Permit: � ,' . :� , � � <br />• � <br />Signed i . -% _ -'=:—=c--�. / <br />Cus�omer <br />SEE SKETCH ATTACHED <br />iy~ � <br />� <br />,�Q A 1 a �� . _ _ <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved B.y i��= <br />City Enginccr �- <br />� �. <br />Issued By � • ' -� <br />. <br />/' <br />Inspection By �� -s'?�---+-� � <br />Date Inspected � - rY ' � � <br />• <br />�i: r . �.i !e�.}r+�; <br />!' ' <br />�� <br />