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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 2-!042 DATE //- /0 - 77 <br />Service Address 3 r/U i4 <br />Billing Addresses �, i� -t--, <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By— <br />Address- <br />Phone — <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descripti <br />Tvnn Pormh• <br />nun im na <br />Block_ <br />CHART NO. • <br />Z5 <br />7 � <br />Utility Account No. <br />Permit Fee_ <br />i Connection Charge(s)= <br />Total Fee <br />Signed._ <br />Customer <br />— � 1 <br />Sewer District_ ... <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S. E, W <br />Approved By <br />City Engineer i <br />Issued By_( <br />—T— <br />Inspection By_ 4 _ <br />Date.l nspecteo__�� <br />