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everett <br />e <br />City of Everett <br />Engineering & Community S��rvices <br />Sewer A►pplir�tion and �ermit <br />CHART NOi� '� <br />' � �,` r <br />; ,�_'�� � , <br />�-2-���:::. <br />/ <br />c <br />; n i� , 'i DATE _ .. _ L ----- ---- --- <br />NO. __ _ _ — <br />Service Address � i'� "� Utility Account No. <br />i., .. L:._.l��' <br />Billing Address � k��� '' " _ � ` Permit Fea_ — <br />. . �c.� ,.�------� <br />City, State, Zip r' "• � .:onnection Charqels) <br />Owner ((Vlortgagor) Tutal Fee____ -------- <br />Billing Namc <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot '" <br />Plat <br />Unplatted Descriptio <br />Type Permit: <br />Remarks: <br />;� j <br />Signed � ' � — <br />CUstomur <br />Sewer District __. _— — <br />Monthly Sewer Service _—. <br />_ Monthly Sewer Constr. <br />— Trunl<_ __ <br />Lateral � <br />Abuttinc� Lo[ Llne <br />N, S, E, W <br />3 <br />SEE SKETCN ATTACFIED <br />____-0.�12.,1'. ... i.. <br />Approved By <br />I ssu ed <br />Enginccr <br />Inspection B����— <br />Date Inspected � —�a � ��--- <br />NC. <br />,�\ .1,:. r''}�j'f <br />'�r..�.: ti�:�� l �'•i:.:'a2i.ii <br />