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everett <br />e <br />City of Everett <br />Engineeri�g & Communi!y Services <br />Sewer Application and Permit <br />CHART N0. 'y � 3`� `�9—� <br />�� 5 � L d <br />rvo. 22393 DATE '�/�'';/�� � <br />Service Address S�'1 i( r� r": :•'= Utility Account No. <br />i <br />Billing Address� O �Y�� U�� Permit Fee <br />City, State, Zip %�"f''`f'�%•���d _-`,:�'v, `��-- /.✓ Connection Charge� <br />Owner (Mortgagor) ,�� �/-i�i'�'.-�.✓ ->'!� Total Fee <br />Billing Name - - ✓ <br />� ' � : ' <br />Connection By= -r� % <br />Address '% <br />DESCRIPTION: <br />Lot '��— � % Block <br />Plat �::� ' � <br />Unplatted Description <br />Type Permit: ;�[`. — � � <br />Remarks: �7,, �� (� <br />a� rl.J . p �Gt�fC,u .�.T <br />� <br />/ � xi.Z <br />� , 4 . /%�i ��%. <br />. i/ c.�'1 d�l �.i'.�.: <br />..r. .,_� <br />i-e e e�.-- G" G'n <br />P,L• �-�'y'�t <br />� �l�-i Li-at.a <br />� /� <br />0 <br />SEE SKETCH ATTACHED <br />`/<%Y/� • <br />Signed � / �; <br />Customer <br />$CWBf �ISlfICt <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />'"'�`r' libutting Lot Line <br />!1 a-� N, S� E. W <br />Approved By ' � <br />Ciry Enginecr <br />Issued By_ <br />Inspection <br />Datelnspe <br />NO <br />it. <br />