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everen � <br /> :; 1 <br /> � ' � <br /> , � . <br /> City of Everett <br /> Engineering & Community Services <br /> �ewer Appiication and Permit <br /> �:�o. 22407 oarE - .�'- ! ; <br /> Service Address ����f . -� Utility Account No. <br /> � :%_,�.-� <br /> � Billing Address ' �� � . - •_,- Permit Fee �� <br /> City, State, Zip _ ' i � �' : � Connection Charge(s) <br /> Owner QJlortgagor) / Total Fee ' '� �� <br /> Billing Name � �--� <br /> � .r % <br /> Connection By -�� • . r ; <br /> r <br /> Address `��- � ' %� :� - _ Signed / �'' � " -� <br /> cu:tortxr <br /> i� , � / .% � <br /> Phone ' �'JO <br /> DESCRIPTION: Sewer District_ ' ` <br /> Lot_ � Block%�� / <br /> � Plat � � - / ; � Monthly Sewer Service <br /> Unplatted Descriptiun_ Monthly Se�ver Cor„tr. <br /> I <br /> � Type PermiL ,�j._ _ --� ` �' Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> _ N, S. E, lN_____ ___ ft. <br /> � <br /> Apuroved By _ � ��. <br /> ' Ciry Engmcer � <br /> -- � <br /> — -- — Issued Qy—�------� ' �. . <br /> -- --- I�upec:tion 3Y --- -- <br /> _ L�ate Inspected____ _ <br /> p -- <br /> SEE SKETCH ATTACHED N0. i 2 �: 07 <br /> !NSPECIIi�„ <br />