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everett <br />e <br />City of Everet: <br />Engineering & Community Services <br />Sewer Application and Permit <br />�- �,- <br />NO. ; I E;;' � DATE � �7�7 <br />Service Address_%� /� /�.�/�'f/ �!i1/Yj) p,{' Utility Account N <br />CHART N0. �S % ' � � •;� ' <br />, _ -r„ -1> <br />Billing Addressln /—' 1�i9 ii'iS /� /i'//�/= Permit Fee � v <br />City, State, Zip�[ �/_• TT /f�,1 `%Y'-�a '� Connection Charge(s) <br />Owner (Mortgagor�� ii'7<!i/,� �/'-,q,yp �- ,f/� Total Fee .J U' <br />Billing Name �.� M � <br />Connection By �� iY7 F <br />Address �n , .•�—t''•�/ �� / ) /°/!•/- _ <br />Phone ? �_� - 3 % '� rc <br />," / �? <br />Signed ��:.r�[-' iri �/c.cs, .#` �_ <br />cu:romcr <br />DESCRIPTION: Sewer District � y <br />Lot == � _ Block <br />Alat � /'%f te ��!/. /''q /' /� _ Monthly Sewer Service— � • 5 U <br />Unplatted Description F�u �,- /Y ��' Monthly Sewer Constr. <br />0 <br />:l�Gl17 J'L A 7 � o' - 33 <br />Type Permit: ��r- �y� ; ��, r, ..- . .� ��„ Trunk % / ✓ <br />Remarks: <br />ETCH ATTACHED <br />� , �� i'�;... <br />Late�dl ? ' <br />� <br />Abutting Lot Line <br />N, S, E, W <br />Approved Bv� /�.r NN / �/�� <br />Gry Engineer <br />Issued By�. -.- � _ _� <br />InspectionBy -r_�_� <br />Date Inspected� 7�'�7r% <br />NO. <br />� <br />