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, r .� �_ � �_ �.� <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Appiicction and Permit <br />NO. �� `�� �J c� r� DATE (,i __',%. <br />'` ' �,.' � <br />Service Address ^1� � � � =� ��� �' — <br />Billing Address ��zU � ' �� ' 4<""' • <br />City, State, Zip �;,, • � ;'�%^' . f�''�� / <br />. <br />J <br />Owner �Mortgagor) ��� ��1� • F,'-ti ' �-?� <br />Billing Name '"�J� - r� '--� <br />Connection By " �-- <br />Phone `:S"' - ��%� <br />DESC�.IP�FI ON: <br />Lot �� �= N Block � �% -' <br />__ , <br />Plat <s�_ .j,�i� _._ � �� �,j. <br />Unplatted Descriptior, <br />CHART NO.�� <br />/ <br />•� T�� <br />Utility Account No. <br />�� <br />Permit Fee -��� <br />Connection Charge(s) <br />° _-- <br />Total Fee . �� <br />Signed ' ��� �._-2.� ; .r�"�}�"'_'' <br />Gsiu�hmcr <br />SEESKETCH ATTACHED <br />;�, <br />Y ,, •.` �, ,° •,.' <br />�;�. a! . c a �. <br />Sewer <br />Monthiy Sewer <br />Monthly Sewer Constr. <br />Abutting Lat Line <br />N,S,E,W <br />_ sv <br />Approved By� . �� <br />Ciry EnBincer <br />Issued By �"-%' - � <br />Inspection By ��w�"'''�—ti'---� <br />Date Inspected l�-2��7 � <br />(, , . <br />N0. ' <br />