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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />rvo. 22390 DATE _ �fi`�f � � <br />; <br />Service Address-5�� � �'-�•��� %�•� ; ��� S i. Utility Account N <br />CHART NO. �_o -a��' y <br />��,, ,,�. <br />��. <br />Billing Address �-+^f -- - -'.'-��T i`�,7.. i�x /� Permit Fee_ <br />City, State, Zip �� �•� n�-a/�� i> ��,: 1 S N /,�� � 33 Connection Charge�s) <br />Owner (Mortgagor) �� � � � :' 1�,�+ vi r _� Total <br />Billing Name l� �• r=v�.: i?.aii;r � <br />.. � <br />Connection By < % � i � % � i � i i,z�� . .,, ,� , _ <br />� �"� ' <br />� <br />Address_ r(: '1Ju /,?2 — l'l iv , ui,�:i ;y:',Signed_.=-� ��li_�' ' ,.::-::� ;.��'yrt.� <br />7 •. • ' c�tSmmer <br />Phone f1' S' S� Y.:6�, <br />DESCRIPTION: Sewer District ���- � " <br />Lot -� Block <br />Plat ' <br />� n :. - ,= � , . �a .: i ,z, r ,-; a . :;, Monthly Sewer Service - ' <br />Unplatted Description Monthly Sewer Constr. <br />J <br />SEESKETCH ATTACHED <br />If�!SPGCTIOi�! <br />Latera <br />Abutting Lot Line <br />N,S,E,W, <br />Approved By ' - , <br />City Engineer <br />i' <br />Issued Bv � � 1;i� � - '��- ' <br />�� <br />Inspection By � �- <br />Datelnspected ( �� '— �� <br />