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everett <br />e <br />City of Everett <br />Engineering & Community Scrvices <br />� • <br />Sewer Application and Permit <br />CHART NO.�—' �`d- � � � '��- <br />�� <br />�o y � ��O i �a <br />, <br />N0. 2.l. I� J DATE t� ��-`-' �! <br />Service Address �� �'�� ���'�` �'���--- Utility Account <br />Billing Address ����^�' �� <br />�;; �=: 7C-. I <br />City, State, Zip �� E--�'� Y `' <br />Uwner (Mortgagor) ( ' 1 , �" ' c � � '� Isv � <br />Billing Name '���'�''' � �- <br />r <br />Connection ByL , v �`''+= — •'t=1'- �- "T <br />DESCRIPTION: <br />Lot f�E"_�j Block 4� �' <br />Plat C� ��'7 ;�t �-\� �� <br />Unplatted Desr.ription <br />Permit Fee �� ��`�- E- <br />Connection Charge(s) <br />Total Fee �U"� �t' <br />Signed �.r.�...0 i� ` •�rL'- c.i�k-V'� <br />Customer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral__ <br />tting Lot Line <br />N, S, E, W_ <br />SEESKETCH ATTACHED <br />Ifl5PECTIO(�d <br />� <br />iroved By � ���--�-}t ti-' �• <br />Gry En9ineer . <br />ed By ��i` .L. Q� �. �tJ <br />�ection By��=���.+��-�1 <br />e Inspected � �?—�7r--- <br />NO. , . <br />