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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART N0. �/ ���^' � <br />po 3 T� a <br />�-is-�g <br />��� <br />N0. :-, `� ;_ I �� DATE ��1.�% % � <br />Service Address ����� '`� '/� Utility Account No. <br />� :� <br />BillingAddress_��� ��� �� _ �ertnitFee <br />City,State, Zip ' ,;i'�- � Connection Charge(s) <br />. • <br />- '-�- <br />Owner (Mortgagor) 1 /�._ .-y Total Fee %' U <br />Billing Name <br />Connection By _ ( <br />.� � <br />Address Signed � �-+-� ' <br />Phone � - � <br />DESCRIPTIOfJ: . <br />Lot /'v'`� Bio� <br />Plat v � ; % � � �- � � <br />Unplatted Description <br />Tvoe Permit: � _ ' � <br />Sewer District <br />._-- <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />�butting Lot Line <br />N, S, E, W ft <br />pproved By <br />� City Engineer <br />��SUBC� BV : . � .. _ . / <br />SEE SKETCH ATTACHED <br />li:'.�'�� ! (,I i'�`i <br />ispection By ,n fc _,�- <br />ate Inspected_J�3 �/7� <br />NO. <br />