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'�' ll.. �_ 7i <br />iuora., et.,�, z, <br />es erett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicetion and Permi� <br />N0. c.' =" ��. : _, DATE -� /i ; `/ ,f <br />Service Address �{�- � -%=�. i:. G� r� r (. <br />BillingAddress �� �� '--��-. --�J `--' - <br />-, <br />City, State, Zip '� ;'✓•� �'/ � �J <br />Owner (Mortgagor) ' • / � . _ - � <br />Billing Name ! � � � <br />Connection By ,.::.. ,-.i:� <br />Address � �_ <br />Phone " % `/ - .i j 7 <br />DESCRIPTION: <br />Lot � Block <br />Plat -' i � � :.. .i/ . / � �� <br />Unplatted Descr <br />CHART NO._/""� ��-- 2 T 7 <br />�n,5 i�.p <br />� /6 -�f �. <br />i '� <br />Utility Account No. -�' �%- �� 7� - O�1 <br />�I� <br />Permit Fee_ �v <br />s�-- <br />Connection Charge(s)- 7 SO <br />pu <br />Total Fee -S i U '�� <br />SEESKETCH ATTACHED <br />� �� If1SPEC1'IOfV <br />Sewer District�/ � .—: I � <br />Monthly Sewer Service_ �'� � 'S d <br />Monthly Sewer Constr <br />Trunk �'�r <br />Lateral _� ," s <br />Abutting Lot Line <br />N, S, E, W. <br />_�.= ' . <br />APPrOved By �' ' ti/i* ,. v, c.....n <br />City Engineer <br />,, ; r. <br />i <br />Issued By � - -��� � [ <br />Inspection B _ � / � <br />Date Inspected / � `" 3�'�� <br />NO. c' _ _:' �� <br />ie <br />