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everet� - � - • <br />e <br />City of Everett <br />Engineering & Community Services <br />%: ��� E <br />,� Z5-7i <br />Sewer Application and Permit <br />N0. 2�72� DATE /� �- ��f <br />Service Address .,'�`_, � ',r - � �'� �— <br />Billing Address -^�%% ` � =�/�� � <br />City, State, Zip � � '!� , "' ,� '" <br />_..4 � <br />Owner (Mortgagor) '�`',� %� ✓ <br />Billing �ame - � _- <br />Cunnection By �%-� - _ _ <br />Address <br />Phone_� � - ,l! "� -" <br />DESCRIPTION: <br />L�o*j ' d, . O�ack � - <br />Plat �� - - % ' <br />Unplatted Description� <br />CHART NO..���G -/' -% <br />Utility Account No. <br />Permit <br />Connection <br />c� 5 �� <br />� ,�-�s <br />(-/J <br />:� <br />�_� <br />_n ✓i <br />Total Fee �', i7 _ <br />SEE SKETCH ATTACHED <br />I�1SP�CllO(�! <br />Gustomer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral _ <br />Abutting Lot Line <br />N, S, E, W;`.1�. '� ft. <br />Approved <br />I ssu ed <br />- �, <br />Ci�y Engincer <br />Inspection By -�� � �'�''�� �� <br />�_ �/ �,�� <br />Date I�spected "� - � / <br />NO. <br />