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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />rvo. 22248 DATE ����/%� <br />Service Address_ 1 %�/ �� <���` • 7'�' <br />Billing Address ("` � �X •'��� Z� . �� - <br />�, /. <br />Citv, State, Zip %'.; _ . , jtir �f0 � <br />i/ <br />Owner (Mor[gagor�l ��-� ': ./ //�u�i� <br />i <br />Billing Name %%.'- _c� <br />Connection Bv__ - �'-�`'� ��- `-� <br />Phone 7��^ /�� % <br />DESCRIPTION: <br />Lot /�� Block�_ <br />Plat _. �- ' T � % �• � <br />Unplatted Description � <br />CHART NO.Y � � ' - ' i <br />� ' <br />Utility Accaunt No. <br />Permit <br />� <br />, <br />�i <br />�-3Y' "��I G'O <br />D � <br />� / 7i' <br />Connection Charge(s) -� <br />e� <br />Total Fee 3n <br />) ^� � <br />�. � j�!/� - -n <br />; = .,�✓/ /`� � ���"/�!%, <br />Signed_/'%.r%' � �': /' � i' <br />Customer • <br />j' <br />� <br />Sewer District 1 G :1:.--- - ( � <br />Monthly Sewer Service -'% : . .- � - � <br />Monthly Sewer Constr, <br />0 <br />SEE SKETCH ATTACHED <br />c^.�. . . , , .; <. , , <br />_ _ : �,. _. <br />yv <br />`/� Lateral <br />r • �D <br />=' %6 <br />�utting Lot Li <br />N, S, E� �Q Tt. <br />�� "i � . <br />proved By . i�'-, - <br />citvEngineer ,�: <br />�'. ' j <br />1Cd BV " ' <br />)C'CIICII <br />0� <br />rvo. �%��o <br />INSP[CTION <br />.'1`..:.. [..>:Y�. f 4 .. , � <br />