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everett <br />e <br />City of Everett <br />Engineering F'x Community Services <br />Sewer Application and Permii� <br />n,o. 22246 DATE �/%��%� L <br />Service Address ��7� ^ - l' �?/ '�"" Utility Account N <br />,� <br />Billing Address `� �' '� ��l Permit Fee � <br />:; <br />�. <br />� <br />oj <br />City, State, Zip - - l :���. ���;� Connection Chargels)_ <br />^� , < ,I <br />Owner (Mortgagor�_� �'� - � - � Total Fee � � <br />� <br />Billing Name - �-� <br />.% <br />Connection By__ -"`'- <br />Signed <br />%I�- %�.v <br />D[SCRIPTION: <br />Lot �"�� � / Block � <br />Plai •,--- '' % � / /;� . _ / . <br />Unplatted Description — <br />. . . <br />�� we:- r... . , t . .ssY.,��i.x:;:;._. _ :�.. <br />INSP�CTIOi! <br />�� <br />Sewer Dis[rict <br />Monthly Sewer Service '" �' <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line — , � % <br />N S E W !i. -, _ <br />APProved By �/ <br />City Engineer <br />Issued By _��` <br />Inspection <br />e <br />Date Inspected _ _ _.____ <br />rvo. 2224� <br />f'`.� •.._.. i <br />: 4' <br />� <br />