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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />rvo. 2 2 3 G 2 DATE _�/ �� ' <br />Service Address � � ` `"" <br />, 7. ��� i,. � i ,� , f% 11! <br />Billing Address � �• - ` � <br />I <br />' -:;,,� �,+',r %� % �. ' o <br />City, State, Zip , •✓ �''� <br />. r <br />Owner (Mortgagor) �� � <br />CHART N <br />� <br />��' -, �-; -, � -t. <br />�u:. �� �• ,, <br />-�i' ,; <br />,�� - <br />Utility Account No. <br />Permit <br />Connection Chargels) <br />Total <br />�' <br />Billing Name <br />> � �i " . <br />".���. ' . <br />Connection By � � ,.'� ��� <br />,) . , � ��''� <br />Address � I��1 �TH YG. ��% Signed� '�2'��-�_ --�+-' ��'�_ <br />� � / ,C. y Z�1 � . Customer <br />Phone 7 4' � ` 40�� <br />DESC�IPTION: <br />Lot � ' � � Block � <br />Plat : � <br />Unplatted Description <br />Type Permit: <br />SEE SKETCH ATTACHED <br />�„ � il�,'�' <br />Sewer District - <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk ' <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Cny Engineer <br />Issued <br />ft. <br />� , <br />Inspection By ',�z - �- ""' ` �' ` <br />� <br />Datelnspected �'-� 1�-� �•S _ <br />NO. <br />