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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART N0. `� ` -- — <br />� �n � �� �' �- <br />Z_2�2 9 <br />� �� . <br />, � <br />NO. F'��'_�i;)`� DATE ' ''` � <br />Service Address i'�� �` Utility Account PJo._:' <br />_ .-i� <br />Billing Address - ' J ' " � •'✓ : :'- Permit Fee '�� <br />� �i <br />� �. <br />CitY', State, Zip <br />,�.%;� Connection Chargels�,'i� <br />pwner (Mortgagor�_ � <br />I F,.., i �� � <br />Bi;'ing Na <br />�� <br />Gonnection <br />Phone % J�/_ ; � - �/ <br />DESCRIPTION: <br />Lot _ � -� <br />Plat <br />Unplatted Descriptio <br />Block �� <br />Tota <br />� ', <br />� <br />j <br />' > � <br />" — , <br />i <br />�� � <br />. I <br />'/ � <br />' r .f .:' % <br />Signed ` <br />Customer � <br />Sewer District ' �� � ( �� <br />Monchly Sewer Service • ' V <br />_ Monthly Sewer Constr. <br />Tnink �' � <br />SEE SKETCH ATTACHED <br />S` _: /O. � �� <br />� 'i ,.1U.p;' <br />Lateral - � • <br />Abutting Lot Line <br />N, S, E, W <br />- ,, <br />-� , �� ' <br />Approved Bq <br />Ciry Engineer / <br />Issued BY ' <br />Inspection By � � <br />v � -' <br />Datelnspected= k�- L � — %� <br />� <br />� ,. � .. + � `rr J ,' �;.. ,.: � . <br />.._ -- -- .. . . . 7 <br />