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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewe�r Applicatien and Permit <br />N0. _ o :) � <br />DATE � / <br />Service Address ,�'� �' <br />Billing r.ddress_ <br />City, State, Zip <br />Owner (Mortgagor�_ - <br />Bili:na Name <br />' � � <br />Connection By <br />DESCR�PTION: <br />Lot _ <br />Plat — <br />Unplatted Gescri <br />Block — <br />Type Permit: <br />Remarks: 1/� � ,e'O��i ��%� f� i�✓ /�� <br />.1' �7PcA. <br />CHART N0. "� ~� ^� 1 <br />�o � ��� <br />�_�.G'- 7$' <br />r�' <br />� _� <br />,._ ., <br />''' �` i <br />�� �_ <br />25 19T9 <br />n <br />----�,..— ............... ....._ . . <br />`� CITY OF EVERETT <br />Utility Accoil'dt�iA"o Works Depl <br />Permit Fee_ ' '-"' — <br />Connection Chargels) <br />Total Fee —' <br />Signed - <br />Cystomer <br />/ <br />SEE SKETCH ATTACHED <br />� � _� cnn� <br />r. � �-,-.'*.'q"',F---c= <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />it. <br />�� '. <br />Approved By � / , <br />CitV Engineer <br />( <br />Issued By � ' —{ . <br />Inspection By � ���'�'v��? <br />Date I nspected /� � /�O � <br />NO. , ., <br />I'-. ... ., � -.. <br />