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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />. <br />Sewer Application and Permit <br />No. 2 2 � 6 7 DATE �/ �./ 7 1 <br />, <br />Service Address 7 ")_ / y % / :' ' . ( <br />Billing Addro;,_ � �' �� ,%.'! ..� � ,' <br />City, State, Zip - "f�..Z' � �. - / , � , � <br />Owner (Mortgagor) •' . r'�•,� <br />Bi;ling Name ' ' • : _._. <br />" ( <br />Connection By �=r<:,,s-._;... <br />DESCRIPTION: <br />Lot ` <br />Plat _ -' ,- , <br />Block -= <br />CHART NO.J,L �' <br />,��, �"-�=� <br />/— 2Z— <br />� �. <br />7 9► <br />,_, . <br />Utiliry Account No. `� ;--�<'J`r'- '% 5? J� <br />.. -J <br />Permit Fee �s.� - <br />Connection Charge(s) 5 �v �, <br />Total Fee "�� 'J <br />i i� <br />Signed_ �..t`�, jC `_.: �l i . , - <br />Customcr <br />Sewer D <br />Monthly Sewer Service_ <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />SEE SKETCH ATTACHED <br />If�;SPECTIOi! <br />Tru <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By �� .-. �. <br />Clry Engineer <br />% . ` <br />/ <br />IssuedBy _ -✓ .:''- <br />� � �/ <br />nspection B �� <br />)ate Inspected_ � �� � 7� <br />`T---- <br />N0. .� , t\ � <br />