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� <br />everett <br />e - <br />City of Everett <br />� <br />Engineering & Comnwnity Services �� �/ . �{, <br />�, <br />Sewer Application ar�c� Perm� <br />CHART N0. r' � �� ' ^��� <br />� f �� i <br />e—7 � —;----�_.. <br />;,, � , <br />.,. �_ 3 _ -� . <br />; <br />rvo. 2 2 4 5 7 DATE ,,� ,-' :' - i X LL <br />. 1 <br />Service Address --�� �J � '�� ' '� -- � . — /�Jtility Account No. <br />/ <br />Billing Addres <br />City, State, 2i <br />Owner (Mortg <br />Permit Fee <br />Connection Ch <br />Total Fee <br />j��� �C <br />-:o /�✓ /'"o .� i_,' EG1� <br />- _ : _, `�-- <br />Billing N�. a_ <br />Connection By_ ' � _ <br />Address �' Signed '� %`� � <br />Customer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot 31ock <br />Plat Monthly Sewer Service <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit: _-� � ,;,•< . <br />SEESKETCH ATTACHED <br />IP�aPCCTIt':: <br />Tru <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved 8y ���/: <br />City Engineer <br />Issued By = - <br />I nspection <br />Datelnspected _ <br />� '.1' <br />i <br />