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; <br />everett <br />e <br />City of Everett <br />Engineering & Community S!!rvices <br />CHART N0._/� '�� <br />,>os�-��� <br />!z-G - 7'i� <br />Sewer Appiication and Permit <br />;�, <br />NO. i' r.''; U J DATE / <br />,� , <br />! <br />Service Address_ % � � "� ,.%G � r ; _ .,-,� <br />BillingAddress__ -''; `/ 1 � �'�/� ,:. �� <br />Cit State, 2i - r <br />I / <br />Y, p=. ��i t,... ;. '�� n_ �i �(J �1 <br />l <br />Owner (Mortgagor) ��. * i-.-r , � � .f; , ; . ;/� � <br />.; <br />BillingName :�.�-r,_1 <br />Connection Ev - . . . ,� <br />DESCRIPTION: <br />Lot_7- �` � � Block � %s <br />Plat ':r _ _G ���-- � � <br />Unplatted Descriotion— <br />Type Permit: <br />j <br />Utility Account <br />Permit Fee_ <br />Connection Charge(s) <br />Total Fee <br />'� <br />f� / <br />• ,/ <br />�j a� <br />Signed - �/ ir'.<�)�� ' Z1 r � <br />/ cu:tom <br />SEESKETCH ATTACHED " <br />. , . � �I`:�.;�P:i'ill�;! <br />� f <br />Sewer District = {�+ a-� .,. <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />APProved BY—� '� •., <br />� Ciry Enginecr � . <br />, // <br />Issued By � !v %�:=�- <br />In;pection B'kL:�% ///� �� <br />)ate Inspected_/ Z� %� /,�" <br />NO. , <br />