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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Appiication and Perrr�it <br />CHART NO., `� -- <br />� �Zv��� <br />y%��-� <br />NO. ! � �i � DATE �i//� /%t?� � M <br />Service Address - '" i:' •'''' � : � , � !l�• uc�i�cy a��o��,c rvo. = — J y--'�� T _ o -� <br />„ '�- <br />Billing Address l�l `�f } DI�,l Permit Fee %' <br />a.��' <br />City, State, Zip '�. �`' ' Connection Charge�s) �� �O <br />Owner (M <br />Billing N <br />v <br />Connection BV '� <br />no <br />� ' � Total Fee -J �� � <br />� i � - - :': / �� <br />Address Signed _ <br />� .;ustomer , <br />Phone <br />i i ' %%,l � <br />DESCRIPTION: Sewer Di�:rict � '-�%" � � <br />�ot � Block . SO <br />. ;• i- , � Monthly Sewer Service <br />Piat . � <br />Unplatted Description Monthly Sewr,r Constr. <br />Type Permit: <br />u <br />SEESKETCH ATTACHED <br />.�.-- � --�-_�a+-,• ,'��� i � <br />� -rr'gw" .. � <br />R��• �4�� P s p <br />,A�_ 4 d7y.-'.�.,,yi•iij'k�`�i5�' !r , i�.�.'i�- . <br />Trun <br />6i <br />•.�v �UO <br />¢� <br />Lateral � • � U � ��� <br />Abutting Lot Line <br />N, S, E, W <br />_.�- ' � <br />Approved By "' , ��°' . <br />City"Engineer <br />� - �; <br />Issued 8v �' " - � <br />Inspection By ` / /��2�` <br />Datelnspected � - �� — 7� <br />NO. ; . <br />- ' ;f � :' �r'- d.�! , :� , <br />r �"r:?a'� i: h , . .. ` � � r � ., - � . <br />