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fl <br />everett <br />� <br />� <br />City of 'everett <br />Engineering & Communify Services <br />Sewer Application and Permit <br />� �� �� � �� <br />NO. �_ r i,t �, DATE <br />ServiceAddress �� ���-'7 �t�4e�� Utilty <br />i' <br />Billing Address � � t' •={ �/�� -'�' • � � Per n <br />;- � _.�„, � <<`_. Ci <br />n <br />CHART N0. 1' <br />_ - --�-_ <br />/ . _ �. <br />� <br />; , <br />Account No.✓ �' -S' ' �`� �" _ <br />'Goa i (l '' <br />1 <br />City, State, Zip - 'u.- -4 : � (rr '/: y.^ � Connection <br />� <br />Owner (Mortgagor�: ��'. -'%'�/%-•�'� � .• j ' Total Fee_ <br />i \,� <br />Billing Name ' %�.: -- \ <br />, <br />Connection By_ ; %� - —�` <br />, �4 <br />Address � Signed_``� <br />Phone <br />- y�n o <br />DESCRIPTION: <br />Lot 5� . BIoFk� <br />, <br />Plat !'=' -�^ •r� fi.f <br />Unplatted Description � <br />Type Permit: <br />Remarks: <br />� <br />\. <br />Sewer District 3� , ;..-� � � <br />�•sv <br />Monthly Sewer Service �"` <br />Mvnthly Sewer i.onstr. <br />i <br />�Trunk . ='�-�ebf`J � •r: i <br />Lateral � ' % `-' <br />�,,.� <br />Abutting Lot Line <br />N, S, E, W ft. <br />1� Approved By �% <br />�' ` � ' City E igineer ,� <br />� ` ' ( <br />l/ <br />Issued BV ' � �--� <br />Inspection <br />I Date I <br />I a <br />; SEESKETCH ATTACH[D <br />I INSPGC IlOi � <br />1 � <br />NO. <br />