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cvcretl <br />e <br />City of Everett <br />Engineering & Cammuniry Services <br />Sewer Application and Perrnit <br />N0. ' <br />,_ ,_ �, <br />DATE ��� " � 4 � � <br />CHART NO. I�� I '� � '�- �j %� <br />ty � <br />� �'� ... <br />�� -�� <br />, <br />• / ' ;' . <br />Service Address ���� � ���I-" "r� l C, %'-:�Utility Account No. <br />% <br />BillingAddress�nl� �����'�'`''� PermitFee ��� <br />/ i <br />City, State, Zip �� � ��� l�l %' ��� Connection Chargels) �' <br />/ . �, <br />Owner IMortgagor)�./! �� �� e��- �"� =� • Total Fee J � U� <br />/ �i <br />Billing Name -��:��`f - <br />Connection By �'�"' ' `�'v <br />,_,, � �r--.- <br />Signed �4�, % `-i� /, 1'i �t:f✓ - <br />Address ,. �a.�o�r <br />Phone �� �" y� /� / � <br />DESCRIPTIO : SewerDistrict �� �-!-�-yL--- <br />Lot Block - - - Monthly Sewer Service �' Sa <br />Plat %�l: , , � %! - - ._ �.r� <br />Unptatted Description � Monthly Sewer Constr. <br />� <br />Type Permit: ,"-/ _� <br />Remarks: <br />SEE SKETCH ATTACHED <br />��� IIdSPECTIOn <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved BY ' ��` - " • ` ' ' <br />c�tv E�p�nCR <br />Issued BY '� . ' "`. �— <br />� <br />Inspection B <br />Datelnspected a - '� � �� <br />N0. ,:: ' . .. . <br />, ,_. y-'e�.a t� <br />