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� CHANT N0. � <br /> everetl <br /> , � /�o s ;�/� <br /> / - 2 0 - 7� <br /> � City of Everett /��� <br /> / � w � <br /> I Engineering & Community Services <br /> � <br /> � Sewer Application and Permit <br /> i <br /> � N0. � , . i �i `) DATE ����7 <br /> I <br /> � Service Address �-� � �=�-- =�-�`���� � Y`.s•T Utility Account No. � "� �� ' � �� < <- <br /> 6illin Address fJ�-? �J� •�7� 7 � � c' <br /> g Permit Fee. <br /> ' City, State, Zip �� �4'�--�% ���1 Z C Connection Charge�s) � -` -� ' �4 ��'� �' ' <br /> i <br /> + c � <br /> Owner (Mortgagorl L--' I��- ;-%"'. ' f-It�-+�il�..' _ Total Fee -- �- <br /> Billing Name ��--�/�/�' �E- <br /> �� iU':L. <br /> Connection By :�x <br /> r � ' <br /> '� i �'.,'�� <br /> Address ' •�-'� � > +� . 7 JGs' Signed • /:�: ! =i',i<• _ <br /> ' / ustomer <br /> _.� ,�..7. —(JG`� L.'��� <br /> Phone <br /> DESCRIPTION: Sewer District ��� r� <br /> _.! ��. <br /> Lot•�-' ( �- �- Block �p-' Monthly Sewer Service G' �''� <br /> Plat `�r.,: � �. :J,�� e iU 1�.�:�,Jn_, <br /> Unplatted Description Monthly Sewer Constr. <br /> � � Trunk � � �� <br /> + Type Permit: ��;.{, �__,�_ll_)e_��'rc' :� � <br /> � _ Lateral { �' _ <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W_ __it. <br /> Approved By �- . //�.,� /,.�.,., c� — <br /> City EnBineer <br /> �I � � , )L C- �s /J .0 <br /> — Issued By�--�--.-_- '� <br /> � <br /> I <br /> i Inspection [3y_�V {�1 N � d T" . <br /> I — <br /> ' Datelnspected �y Z� 7 <br /> � o -- ---- f-- <br /> � SEESKETCH ATTACHED N0. <br /> � . . . .� �;!'i .-:11�.'��fJ , .,� � .. <br />