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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. �' Z _t �_ ' DATE � '"? � � � <br />Serv��^ Address .� �� � l'/�=-1�r> �-r.'-`'= <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />%r � ' r � <br />Connection By � � �-- r. <br />// , , <br />Address _ <br />Pho <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descripti <br />Block <br />Type Permit:..-7�r/. -2,+,:_:-� <br />CHART N0. S' 3� -� �' - 5 � <br />% �5 � L ,E% j <br />, � <br />s-� 9 - � � <br />��� <br />Utility Account No. <br />Permit Fee ' '� ' �— <br />Connection Charge(s)_ <br />Total Fee_ � <br />� <br />, - , <br />Signed . � :'r.-�./':--✓' _'�. <br />Customer <br />SEE SKETCH ATTACHED <br />..�_ :�.�.. #��� �:�.. ... <br />;r ,n� i;l i . <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />.::. /. � <br />Approved6l - .l�'-.-c-.,: r_.._�__._ <br />wry Engine��r / <br />Issued By �` I �—.-f�`�"+•'Y��/ <br />Inspection By ��-� � -!•��� � <br />Date I nspected �/ —,J %' 7�_ <br />� � • ��: :.�� ,(( .,,�•� <br />Ak d. r ''!Ir ��� <br />