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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. `_ � '� I ;� DATE �'�- I �I �' �' <br />Service Address � �� � <br />Billing <br />� <br />City, State, Zip � -' i <br />Owner (Mortgagor) . <br />Billing N <br />Connection By - <br />CHART N0. �" �`"2g��S� <br />;I <br />.��s �"� � , <br />�� ; <br />Utility Account No._ �'— ^ - �'�' _ %' <br />� � <br />Permit Fee -�v <br />:�.. <br />Connection Charge�s) '� "� �� <br />---- <br />Total Fee % `' <br />Address Signed �1'�' - _l._, i�•�.•..>,e,. c,r� <br />Cusrome- ) <br />Phone , ; � ` <br />DESCRIPTION: Sewer District - F� T <br />Lot � � Block � ,: � J <br />Plat . Monthly Sewer Service <br />Unplatted Description � Monthly Sewer Constr. <br />Tvoe Permit: , - <br />SEE SKETCH ATTACHED <br />, ; '.:��. <br />IMSPECTI(�tJ <br />i � <br />Trunk / � ' �"' <br />,� <br />Latcral - - 5� i �O <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By_ . �.� <br />Clly ngineer <br />' \ <br />Issued By - ' — � <br />Inspection By � <br />Date Inspected f a.—" l5�" �O <br />N0. <br />