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f <br />everett <br />e <br />City of Everett <br />Engineering & Cnmmunity Services <br />Sewer Application and Permit <br />CHART NO.��%'�� <br />��� <br />�,n;»- <br />.;��r.� <br />� <br />N0. r,� F� ;? 7 DATE 1�- i/ -"T,s' � <br />Senice Address=L'r � - ' �� �' " / Utility Account No. -' ' �' " "� � % � <br />� <br />Billing Address ✓�• `-= i y-=� � _ Permit Fee +'�� _ <br />� . :�r �-� ^'r <br />City, State, Zip /' ' .+:E. '%� -"J� Connection Charge�s) i/u <br />Owner (Mortgagor) / , � <��� _--,: � Total Fee �'� � _ <br />Billing Nsme <br />Connection By � <br />Address <br />? �. ��� J <br />Pl,.,nn . S J <br />DESCRIPTION: Sewer District `-� <br />Loi � Block <br />Plat Monthly Sewer Service <br />Unplatted Description .� f' �-- �-� ��� Monthly Sewer Constr. <br />_, �/ z,� . � <br />/�'�� Trunk <br />.y <br />��° Lateral <br />SEE SKETCH ATTACHED <br />INSPCC1lON <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />ISSUCd <br />Ci�y Engineer <br />Inspection By� <br />Date Inspected�r—Z 6� %� _ <br />NO. � <br />