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a <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application ancf Permit <br />N0. E�� �;.1,� DATE � " '�I <br />CHART NO._� �-3� �-'�.�� <br />,�o � r LJ �"� l � <br />_>�� // �-�-�- � <br />Service Address >'v ' Utility Account No. <br />., _'i.i <br />Billing Address- XJ�� � �'J,� �, "% �'_ Permit Fee �� ' <br />City, State, Zip :�l� -.<. .,-.,,.%'F` %f.jf`•%t :' ;i f) Connection Charge(s� <br />r �� <br />Ow�er (Mortgagor) ��-�w /�'i:- % Total Fee ^` <br />/� <br />Billing Name <br />Connection Bv _ � <br />Address �'�^�� .'� ' -T,':`,.-c . Signed _ <br />Cuslor <br />Phone - ' � ' � � " '�. <br />DESCRIPTION: Sewer District <br />Lot � - �7 Block� , <br />/ '- Monthl Sewer Service. <br />Plat ..�. l % �.,_: <�,.� -��r/• .'�! Y <br />Unplatted Des�ription Monthly Sewer Constr. <br />Tvne Permit• <br />SEESKETCH ATTACHED <br />,., <br />,�� �%.' � <br />, � �.r'•� i <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />,,_=.. �-' �)� - <br />Approved 6� - .G!-Fi�•�-L�,...� <br />i�y Enflinecr ,/J <br />Issued By�`'. � --:-`•'-,�-, . <br />Inspection By /V��"�� <br />Date Inspected �/�7f 77 <br />,o � ;' , •' .,��.� <br />