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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />� / <br />NO. � ��.L.� ( DATE � '�-�" / ` <br />CHART N�1� ��Z' � � <br />,,��s� �� <br />g-z �= � �' <br />�� G• r�-' <br />U� <br />�' 3 '' � �� ��' � ' �''-'--tltiliry Account Nu. <br />Service Address , <br />• ��. <br />. / '" � /' F ` ,'• -- <br />BillingAddress ' � " � �'l'' -r " J `a'�` , Permit ee <br />_ 1 <br />City, State, Zip '� - ' `r - ! �~ ' `''� Connection Chargels) <br />Owner (Mortgagor) <br />Total Fee � +''' - <br />Billing Name_ <br />� . !— L-- <br />Connection By � ' <br />� ;' <br />Address ' <br />DESCRIPTION: <br />Lot���— Block '' Ul <br />Plat � � � <br />Unplatted DesCription <br />. � , / . -;,,. • � <br />Signed r_ c�stom�. <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />4butting Lot Line <br />N, S, E, W_ <br />SEE SKETCH f.TTACHED <br />, � � ' � <br />� � . i�.4? a� y, ',� 1 "^w '' � <br />�^-(r� S� ��:�"ult'q:�.l�y,4y,4..yii�..µ'.,`<LiR�+. .y.�5: n � a'i� <br />I��I'f:� 1.�'.' i'. <br />Approved By -r/ <br />Ciry Enginecr , <br />� .. i. <br />Issued Ry �'� <br />% <br />Inspection By �-` � � <br />Date Inspected �d — ;� /—l�----- <br />• <br />. . � : �y'� Y'S( iu <br />i 1�f� � <br />I � .. � ,h,: r S;R <br />