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n <br />evereft <br />e <br />City of Everett <br />Engineering & Community Services <br />CHART N0./i�,ll—.�-��7 <br />� <br />� ri <br />�0 5 T�.- � <br />�/� � I � � � <br />Sewer Appli�ation ar�d Permit <br />NO. ;�� ��)� DATE 1��-I��'" 7� <br />Service Address_l�' � g i`��f `' j' �>.� <br />i-- � i� <br />Billing Address •�"' �'• =.-�f- "✓ � , �� <br />l� <br />CitY.State, Zip _- i�.., ,..,. . � T ,:!/'t . %�J.'i6 <br />. y � <br />Owner (Mortgagor) � ^"f <: .; �_-, .. /p - �!„ -� . <br />Billing Name_ .-: � �.- . , <br />Connection By %'���-�'��.�--� <br />Address <br />Phnna / ��— ���/�i�e+ <br />DESCFIPTION: <br />Lot "Z Block }� � <br />Plat - . � C.::.:� . � <br />Unplatted Description _ <br />Utility Account <br />Permit Fee—_ <br />Y� `� <br />Connection Charge�s)_ <br />Yo ='' <br />Total Fee <br />SEE SKETCH ATTACHED <br />I`ISPLC: li?i�: <br />C�CK p0. 2BJ <br />Cusromer <br />Sewer District <br />�- <br />Monthly Sewer Seivice_-'� - _-.-* �-• �_� <br />Manthly Sewer Constr. <br />I_a i Ara <br />Abutting Lot Line _ <br />N, S, E, W—/1; , c%, I ft. <br />Approved By " ' %'/ <br />Ciry Engineer �, <br />l <br />Issued By �" � ' ��_" - >/ <br />Inspection By��c�-> �'�Y��� <br />Datelnspected ` // S <br />NQ ' �, <br />