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m <br />everett <br />e <br />City of Everett <br />Enyineering & Community Services <br />Sewer Application cnd Permit <br />N0. l? ,;: ;� DATE /�'�,'�, <br />Service Address _ � ,�� .�J % <br />Billing Address ` �' <br />, -. � <br />CHART NO. �L> U — / % <br />� ����� � 4 <br />�-�-�� <br />Utility Account No. <br />ce.:=�-- �--"" <br />Permit Fee i'�-� <br />City, State, Zip - " � � _ i.ir.Connection Chargels) " ���� <br />Owner �Mortgagor) r" ' � �Total Fee -�<`� � <br />Biiling Name -- <br />'� <br />Connection By �� <br />;' ,� <br />Address .Signed � ._ � <br />., ustomer . <br />Phone / /� - % %/�"'j <br />/ ,. <br />DESCRIPTION: <br />Lot - � - � Block <br />Plat � , , <br />Unplatted <br />Type Permit: <br />.,� SEE SKETCH ATTACHED <br />�r,s�F�c,��iori <br />Sewer <br />Monthly Sewer <br />Nlonthly Sewer Constr. <br />Trunk__ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />.,'<J <br />Approved By' <br />Ciry Engineer <br />Issued By_ � <br />Inspection ` Gch-�� <br />Date Inspected � �07 ' <br />N0. _ <br />� <br />�- , <br />� <br />