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everetl <br />e <br />City of Everett <br />E�gineering & Community Services <br />Sewer Application and Permit <br />NO. _' % �i ; I;� DATE � / '��� <br />ServiceAddress �^�-� �-� •ti�^ �'' <br />._..-y . <br />BillingAddress �C)-*'� �'°�^ �-% ' - --�=- <br />i' �-; . <br />City, State, Zip �_ �__.-*_ '� ,�%r� �f�n�U ,} <br />'� ,_- / -� <br />Owner (Mortgagor�_� % _,: .- .� <br />Billing Name -�W ==� �-- <br />. <br />Connection By_ __ _ _- _c__ <br />Phone_ 3 .� � — .3 J� Z <br />CHART N0: ✓ ' ' � ` = <br />/ �S ���� <br />�,--�.�-� a <br />��i <br />_7_ //_ . ��� ;i� <br />Utility Account No. '- � � <br />-7 '�-'" <br />Permit Fee -� d <br />Connection Charge�s). <br />Total Fee_ �'-� <br />r ,� <br />Signed ' % _'� <br />Cuslomer <br />DESCRIPTION: Sewer District <br />Lot ^��� ��' ^� Block S�r� _ <br />Plat'!� � /- /i Monthly Sewer Service ' ' '' <br />Unplatted Description Monthly Sewer Constr. <br />u <br />SEE SKETCH ATTACHED <br />1 � '.; � G' < -. <br />♦ i S� <br />� fi�w �i v fl � .s;1P: <br />Abuttiny Lot Line <br />N, S, E, W <br />Approved 8y - <br />City Engineer —'— <br />/ . <br />Issued B:y.-� - , _��.--� / <br />�-- <br />Inspection B � <br />Date I nspected�� � c��' /lJ <br />., � : - � .'� . �.w'-.D <br />