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evereri <br />� <br />City of Everett <br />Engineering Fi Community Services <br />Sewer Application and Permit <br />NO. " I"�� �� DATE f" j- �� <br />/� . � _ <br />__. f <br />_� G ; �r ; � . � .i.,�'�.� - <br />Service Address <br />/ � <br />Billing Address ����u ' � � — <br />� / <br />City, State, Zip r i'%v "- L-, � <br />' <br />pwner (Mortgagor) � / <br />Billing Name � <br />Cannection By '�-'= � <br />i � � <br />; , i: <br />Address � � ���'A ' �� <br />Phone / �� � <br />DES�RIPTION: .; � <br />- �• —J--�� —_ Block y� <br />PIt -+�7 ��ii �,i'./ <br />Unp�atted Description <br />CHART NO. �'`^� - �'?- �� - <br />n > -7"7 � % <br />Utility Account No. <br />Permit Fee <br />Connection Chargel <br />Total Fee <br />='"` <br />Signed �,s�o�,�� <br />Sewer District — <br />Monthly Sewer Service_ <br />_ �Jlonthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />, .; .., <br />_ � ' ti: <br />,� -«','"a.� <br />\. <br />outting Lot Line <br />N, S, E, W <br />PProved BY ��- <br />Citp Engmcer <br />� <br />�sued ey`'� ' � ; �G--- <br />,�%��`-'�.�_ <br />nspection By <br />� �� <br />Iate Inspected? /�v/� 7 <br />I:,. ; . � , r: �y <br />,�� <br />