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everett <br />� <br />City of Everett <br />Engireering Department <br />Sewer Application and Permit <br />No. 210 3 5 DATE <br />Service Address ,! l � /�, .Y�<<,/ �i <br />Billing Address ��L� `�� c� i 1-i �/ <br />City, State, Zip (li�Ppn� /,r�i� >��, d/ <br />Ow�er (Mortgagor) _ <br />Billing <br />Connection <br />DESCRIPTION: <br />Lot � -. �i.r�'� �/n �� o % L o %J_�(' �fJ j c � �tYu <br />Block �r�^� <br />Division or Addition <br />Type Permit: <br />Remarks: �i ' � <br />Utility Accaunt No. <br />Connection Permit Fee <br />Connection Fee <br />lotal Fee <br />Signed <br />— c�:�o� <br />Sewer District <br />Monthly Sewer Service. <br />— Monthly Sewer Constr. <br />— Trunk <br />Lateral <br />AL•utting Lot Line <br />N, S, E, W_ <br />a <br />SEE SKETCH PTTACHED <br />Approved By_. <br />City En9ineer <br />I SSUC(�i <br />Inspection By_� <br />Date l nspected %' Z1�� y- i S <br />i��'�d�Q . <br />d ��0. �'�� 11�,i. <br />�� � � - fZ;zcc �, s . <br />c � <br />�`� f — Z�-7� <br />