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everett <br />e �� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO.w �� ``� �—Z�_� <br />,� c � r��� <br />�_z�^__?� . <br />NO. ( ' ('�.�3 �i.� � DATE , ��� I <br />�a <br />.,+ �i � <br />Service Address �^�% ' ' , / -Utility Account No. <br />Billi� Address_ i� ��1� • ' �- I -. -�� %'✓ ��- <br />9 fermit Fee � <br />.> � / <br />City, State, Zip_ � ✓•� • % Connec[ion Charge(s) % <br />Owner (Mortgagor) N� ` - _ �� - Total Fee J'� ��- , <br />�� <br />Billing Name � �` - �" ` <br />Connection <br />Address <br />J '1 �7 ' � ���f � <br />DESCRIPTION: <br />Lot - �%- !! Block— <br />Plat ^ <br />Unplatted Description <br />Type Permit: -J � ° ; '. <br />-; <br />Signed ` <br />Customer <br />:. <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />i <br />Approved.By -. .-� i <br />' Ciry Engineer � <br />� � J�� <br />Issued <br />Inspection By� � �.�h�� <br />Date Inspected_/�2—��" <br />N0. <br />-.�ci>I-C, i P.`; ! <br />� � <br />�: 5 - �i i: � . �':���'���� <br />-' ��� . �a, . ,..�:- �:w . . <br />