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` <br />. ^•- /:�� �''�{i <br />/ <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />` ci. � _ ,=;.�., `` /_??.-:%r <br />;� ii t_-_%`a" <br />Sewer Application and Permit <br />NO. �.l.�R�. DAT� �i- � . 7.7 <br />CHART NO. " i- � ' � <br />�p s7'"Gr� <br />G -/�- 7� : <br />i 1 <br />Service Address ' Ip7 �` '` <-" �— Utility Account No. <br />/� • <br />ti <br />� -.,/_. /�: u - : J <br />/ � <br />Billing Address ��-�� _�' - � - �,� •�.�, Permit Fee � =� <br />City,State, Zip � � �t�✓• /%�^U� Connection Charge�s) �"'—'�` <br />. <br />Owner (Mortgagor) - "'✓- !�� � = - • u �-- Total Fee � <br />Billing Name -�---- ' � <br />Connection By - �— <br />Phone -.%� �% ` � /7� <br />DESCRIPTION: <br />Lot�/I - i� <br />Plat �_,__ <br />Jnplatted Descript�6 <br />�l� (�A :f. � <br />a <br />Siyned � i ,: L.......i' ; :: . i / ��...,...--�- - <br />Cusiomer <br />SEE SKETCH ATTACHED <br />�^�<SF'I �,l 10i.! <br />�� <br />Sewer District f � � <br />Monthly Sewer Service 1 <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />fV, S, E, W ft. <br />Approved By - - =� � <br />City Engineer <br />Issued By_ - 1�� <br />Inspection By ^-"'-�"�`'��`� <br />Date Inspected l�n �7a <br />, <br />N0. <br />0 <br />r� <br />