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everett <br />e <br />City of Everett <br />Engine�ring & Community Services <br />Sewer Application and Perm�t <br />� <br />�: <br />CHART NO���r��"��'1� <br />�?s s �'L�� <br />/,t, _ 2/- 7 $' _ <br />/3°'� J�' <br />N0. ���I1 � DATE %"'/�.% j� � <br />. _ . <br />Service Address �/-� �.��=� �� �� �r /Utility Account No. <br />Billing Address Permit Fee �— <br />City, State, Zi <br />�----� <br />Connection Charge(s) <br />Owner (Mortgagor) Total Fee ' �—' <br />Billing Name <br />._.- � <br />Connection By— � -�--C- � ` � � <br />Address /V' Signed , i�=':•=- � ' � :_ /i�. — <br />Cuslomer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot Block <br />Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: " <br />! , � t; ` <br />Remarks: , -., � �; .. , <br />� .. <br />Trun <br />Lateral <br />�Abutting Lat Line <br />' N, S, E, W <br />SEESKETCH ATTACHED <br />INSPECTInf; <br />Approved By . � �.� <br />City Engincer <br />� , <br />Issued B <br />� . <br />Inspection By /" °: '! ;'': '�`, , .. � <br />Date I nsoected ! ? � '� " � % <br />NO. � _ ' , <br />