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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />n,o. 2?_ 5 2 3 DATE [L'/' ^/r� <br />Service Address �'" �' � "� � "� ' "� �/` �''' t =,'� Utiiity Account No. <br />��r <br />Billing Address ` Permit Fee �� - <br />City, State, 2ip Connection Charge(s) � _ <br />; ` / ��—� <br />Owner (Mortgagor) � � �� � TotabFee � <br />� <br />Billing Name <br />• i ,. <br />Cannection By ' ��• �' = `� � _ "•. ' � ' /� . <br />�j, % ���1 -�----�� <br />Address -�d. �,��',• / ��'// Signed Y�'r�i'y,'�C�.j �Y�:"'7!,tt,� I�� ✓ . <br />�� � ^, �1� �� QUSIORIEf - <br />�3�/- ��/F— i� a� .: -j <br />Phone ' �� <br />DESCRIPTION: <br />Lot r ` ��_ � � , B�ock � � <br />Plat '�! l •-� / � <br />Unplatted Description <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Tru nk <br />Lateral__ <br />Abutting Lot Line <br />N, S, E, W_ <br />SEESKETCH ATTACHED <br />. b 'iF.�tF'pr�'�»i <br />: '. . <br />Approvedr8� '-� �/�— _ _ ---- <br />Ciry Enginecr � . <br />i <br />issuedE31' � ------� -- <br />;n;pection By----- <br />Date Inspected <br />r�o. ,?_2523 <br />: .. <br />,� �la;��?.6 r. -�. ��.,i{!:'; 'nia�. <br />