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I <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�lic�ation and Permit <br />NO. ;� � ; �' �j ,�i DATE = `� � � :r _ <br />'/,� d�/ / / <br />CHART N0. �f �' � - z- `�- S� <br />✓�� 5 � � �.� . <br />' � � c� <br />� —5 � <br />Service Address . � � / l Utility Accnunt No. <br />Billing <br />Permit <br />City, State, Zip Connection Charge(s) `-"'"--�� <br />Owner (Mortgagor� f �- - � :' � / Total Fee �� <br />Billing Name �--- <br />i ' � �_ <br />Connection By � � <br />iJ �� � <br />Address Signed_ ' / _. <br />_ customer i <br />DESCflIPTION: Sewer District � � � <br />Lot Block <br />Plat Monthly Sewer Service l= •'�� <br />Unplatted Description _>� t'. �- �- -^ ' i G Monthly Sevrer Constr, <br />Type Permit: <br />Remarks: ��r.c��.�c!'��r, t�.�. ` <br />� �; , ��. �rt:. : � �� . C�d� �- ,f�+�i�' <br />Trunk <br />. , U <br />Lateral / G' <br />ig Lot Line <br />N, S. E, W <br />Approved,By_ • %� <br />Ciry Engmccr <br />Issued Bv ' `"" <br />InspectionBy �f� �� 1� �i � <br />0 <br />� Date I nspected='_- '.� 7- %�� <br />SEESKETCH ATTACHED Np, , <br />ii��z-Pf i, i JN <br />