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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicatian and Permit <br />N0. �; , ,':' , DATE G �1 � �%7 <br />;_ _� <br />CHART NO.� �8 � <br />p�s, �'.o � <br />e <br />Service Address '~ '� ' � � '� � —'� �'�''� '�tility Account No. Gu <br />Billing Address IV /�--` ` � �"- •"� //r -� Permit Fee � <br />U `� <br />�� % /", � �!jj�� %,�'�3 � Connection Chargels) <br />City, State, Zip.,T ,.t �v <br />� • ;' . �O .�' <br />Owner (Mortgagor� ��=L�'` - ^ �` ' ' Total Fee <br />. ! <br />��•'��<' '. f�� '• '. i /- <br />Billing Name ' ` ' — �' <br />Connection By !' " , / �--� <br />� <br />i � .''/,''r„ .�✓r <br />Signed_ <br />Address -- c,�,i�,�,�••� <br />(r /f �� r <br />Phone �"'� R � <br />'� DESCRIPTION: <br />i Lot ' �� ^��� Block /� 3 <br />� �. <br />� Plat �.. ""�- �,z+' <br />I Unplatted Description <br />� �SKETCH ATTACH� <br />� w .� <br />u <br />.!".��.�IIjZ ...:d . <br />Sevder Disirir.t ._ .— . — <br />Monthly Sewer Service_-- <br />Monthry Sewer Constr. <br />Trunk — <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Npproved BY'�� � lr i <br />City Enginecr <br />ISSUed By.4 � ' � <br />Inspection By �''� �����'-�-cl,_�— — <br />i/ <br />Date l nspected ��� � 7 7 <br />N 0. `_ : <br />µ � . .. .. �. 4�: � . > � <br />