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� <br />..,�.- ,y .,,�,_ , � <br />everett <br />� <br />City of Everett <br />Engineering & Comimunity Services <br />Sev�rer Appli�cation and Permit <br />, <br />NO. ;% � �) �' '�_ DATE �— ���/ � <br />CHART NO..]�—Z� <br />�O S %�LzY/ <br />Z-C--7 S' <br />/�� <br />Service Address ��L' Y "� �� Utility Account No._ <br />y.. ,. , ,; � c2 <br />Billing Address • '"�G' -"'� �� '� Permit Fee �' <br />City, State, Zip`'��`=�' ��-' �� . L"` ' �"^ ��.�J Connection Chargels� � <br />. ;' , 3� �— <br />Owner (Mortgagor) � , � -' ' � _ •; �' "= � Total Fee <br />� <br />Connection <br />Address <br />Phone ' '� ` ��.� <br />DESCRIPTION: <br />I Lot �� Block <br />Plat � — J <br />Unplatted Description <br />� Type Permit: J � ( �� <br />� <br />i <br />I <br />, Remarks: <br />�,. <br />/ � �/ ,f� <br />Signed <br />Custumer <br />Sever to 4224 Gr.and app4ars to run acros3 <br />this propQrty <br />Sewer District — <br />Monthly Sewer Service_ -' ' �' `� — <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line � _ <br />N g E W� < ft. <br />_ ,: <br />Approved By- ' �` <br />Gty Engineer � <br />Issued By - — <br />..- <br />�/�� , ; <br />Inspection By_._6.�_L�, � �""=-- <br />Date Inspected �L���/7''� - <br />. . � • <br />♦ . .\.F . . �. • . -. - . j:.�. .� i lii.�.,wf Cr. . •%�, i4 ��,F *1, <br />v l � f 1' <br />