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0 <br />��' ' /- � ,-: , <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application �nd Perrnit <br />N0. � ;_' � � `.� DATE 1� /�� - 7 <br />J�ix✓Q�E s%/�_ <br />ServiceAddress_:1 •�+ i � i. /� <br />BillingAddress Uii'�S _' i• 1� <br />CitY, S[ate, Zip ' : ; ;; fi <br />t � /,� <� , <br />Owner (Mortgagor�_ � _ � __ ,f' . ; , , <br />Billing Name <br />Connection Bv <br />Address <br />Phone_ I %�• - '•� r' <br />DESCRIPTION: <br />lotG- �' l Block <br />Plat _ _ . . /" <br />Unplatted DescripF'ron <br />Type Permit: ,. _ _ � <br />CHART NOL)�'` rZ��j <br />Utility Account Na. � �� '�"� 'c�-� <br />f-, o.i' <br />Permit Fee_ :JO <br />Connection Cliarge( <br />Total <br />, .-i � '�" <br />Signed :. _ .,.��___. <br />Cusromer �— <br />SEESKETCH ATTACHED <br />, . .!�i(�i! <br />� <br />�Sewer District � �_� <br />Monthly Sewer Service , <br />Monthly Sewer Constr. <br />Trunk �. .-,0 /..;-' <br />Lateral "' ' /,� . �,. <br />� <br />Abutting Lot Line <br />N, S. E, tW �D it. <br />Approved By +l <br />��ry Engmcer <br />Issued Bv __�" <br />nspection B C � i C ,�� <br />)ate Insper.ted� � � ` �� <br />r a' � , r ��.. , <br />w:.',.'}�> y -';.� � .�..i, <br />it W ,pu,yl�i��Kf.� S�f. <br />L <br />