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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />rvo. 22725 DATE ��-�- 7� <br />���� -y -y'� ' -� <br />Service Address — <br />Billing Address -��. %�~ •-'ti 3 0� G <br />City, State, Zip _.. r '" =I r%G't ��� �-� <br />Owner (Mortgagorl ! � - - ' / ,-�� <br />.'�.., <br />.f;. <br />Billing Name �- 4' � �� <br />.�: <br />Connection By �--' <br />Phone � ' � ` �� j 'J <br />D�iCRIPTION: <br />.��{.... .�� Block � <br />Plat,�i -.� %�.l.i r:'�,� <br />Unplatted Description <br />CHART N0. � =�U - '" �� ` <br />'i <br />�d 5 C� w <br />�-�z-�� <br />o,� � <br />Utility Account No. <br />6=-� <br />Permit Fee � �� <br />Connection Charge(s) �'!_ <br />-, J � <br />Total Fee_ �� �� <br />Signed <br />Customer <br />SEE SKETCH ATTACHFD <br />; INSPECTION <br />i <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line �, /' / <br />N S E W�/ ,. ,�v,- / ft. <br />.. i, <br />Approved By -J ��' � <br />Ciry Engineer � <br />t `_ / <br />Issued By ``' ' -��"-' t <br />� N> `-,�" <br />Inspection By �`� � �� <br />Datelnspected � <br />-��,�� �;- <br />N0. ._ : ,_ ..) <br />