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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 19 t tJ DATE <br />Service Address <br />Billing Address <br />City, State, Zip (-- V TT <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />(L't <br />Phone <br />I v <br />CHART No.1S—�%ZQ'S <br />Utility Account No. <br />Permit F <br />SKEW <br />r <br />Connection Charge(s) <br />Total Fee <br />Signed �1 z 1�- F'J120-�S/NZirD <br />Customer <br />DESCRIPTION:�;_�rr-t' Sewer District <br />. , . <br />Lot " Block Monthly Sewer Service. <br />Plat <br />� 19"f i <br />�_—�l�iZt-�Y 1 OCT 9 <br />Monthly Sewer Constr. <br />Unplatted Description_ <br />UTILITY UtY+�,tiuiL <br />Trunk <br />Lateral <br />rutting Lot Line <br />N S F W ft' <br />SEE SKETCH ATTACHED <br />INSPECTION <br />1 <br />proved By iA <br />f,ity Engineer <br />sued By <br />.>� <br />ispection By /�'-- "L"�f"= <br />ate Inspected /d " - <br />NO. nip r <br />