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everett � <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />� <br />N0. n �� .3 3 4 DATE : , � � ' <br />� • ', <br />Service Address ' � <br />Biiling Address � � '` �" � ' %/ 1:�, <br />� <br />CitY, State, Zip i �.��' '% '' // l <br />CHART NO. <br />�- �Z ,i ` i � ._ j <br />��s T �� � <br />��- !?-7 Sr' <br />Utility Account No. <br />Permit <br />Connection Charge <br />/� � �'�1 � , <br />Owner (Mortgagnr) ' ` ' Total Fee ' <br />r <br />Billing Name '-*' <br />Connection By � ' - '` <br />Address '7 z- > - �. / ,%; lG Signe ��-/,� , :,� � , t > <br />\ Customer <br />�' ( 4 � � _y/ <br />Phone i ';.t��f 1 <br />�t: ,' - - �', � � i <br />., . _ <br />DESCfiIPTION: <br />Lat(: i �' , � Block ' / % <br />Plat � i' � -r' �l:.P.�, <br />Unplatted Description <br />Type Permit: <br />u <br />SEE SKETCH ATTACHED <br />. .`�;I�f i.: <br />Sewer <br />Monthly Sewer Service " <br />� <br />Monthly Sewer Constr. <br />Trunk <br />La[eral <br />Abutting Lot Line <br />N, S, E, W, <br />.�� •' <br />APProved By _: -'L _. , , <br />Ciry Engineer � <br />Issued By �' . ' <br />Inspection By <br />Datelnspected � — �� - 7�' <br />t-. a�'—`>_:�� `S. ' . , .,` ;•. . . . .. <br />� <br />;,� <br />