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everefl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. �Z�1�� DATE /� I�- %� <br />CHART N0. " � <br />, <br />i�p.,-�'�; j: <br />� - � Z.-r <br />�� <br />^� . .. <br />J' <br />� �i � f� � :�l� .. ,1... _ '' ... � s j� r � / <br />Service Address �� /�'�" !� � i Utility Account No. '" �� ' <br />Q.: - <br />Billing Address ��f �-� > t• ' ^-'�- - Permit Fee_ � � <br />, I % • ._r . _ < <,�--- <br />City, State, Zipc.__, i�'L ' '�' -�' � Connection Charge�s) '� �U <br />i `� 6 � <br />Owner (Mortgagor) � '� - � Total Fee <br />Billing Name <br />0 <br />Connection By -- �. n z <br />Address Signed �Vu 1/.Gt l/Z-� ��"d�� <br />Cus nef <br />— � _ �. <br />Phone � � - _ "' - .� <br />DESCRIPTION: Sewer District '�J -- i Z <br />Lot Block Monthly Sewer Service <br />, Plat <br />Unplatted Description _ �S =1 0 a-� - Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />I��!�,i��[(� Il(�ti <br />�i <br />0 <br />,] . ., o <br />�t _ / O <br />� <br />Abutting Lot L� � <br />N S, E�W' -, 0 ft. <br />Approved�B�-. -:!:�� - <br />Ciry Engincer <br />e. <br />Issued By � -'' ` , <br />Inspe <br />Date <br />NO. <br />P <br />