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1 <br /> N�� i2-z�- -, g � l/ <br /> everett - C!�ART NO.� ��Z�7� � <br /> e �� � � <br /> City of Everett . . . . (( � �"� 7� l�F <br /> � 7; <br /> Engineering & Community Services , �i� <br /> �ewer Application and Permit � <br /> : �� <br /> , <br /> 1 <br /> N0. ! � �I 1 � DATE _,'.�, '��' � <br /> Service Address f i' s � Utility Account No. " - -' , rL- -' �� <br /> �' <br /> Billing Address y :% � / � -� - �"'"'� <br /> f'� ' Permit Fee r' � � <br /> City, State, Zip � - i ' � *� Connection Charge(s) , � -� �� �' <br /> _, . <br /> Owner (Mortgagor) - ;� °y" <br /> ' Total Fee -- - � <br /> r — <br /> Billing Name_.. <br /> �. <br /> Connection By__ __ 4^ <br /> Address • �' I <br /> Signed ' � <br /> P�lOfl@_ J � �— �`� - �� CuStOmer <br /> r� <br /> t, <br /> DESCRIPTION: Sewer District - �% i � � <br /> Lot_ j.� Block <br /> Plat . i " -" '" Monthly Sewer Service • 5 L� <br /> Unplatted Description ? <br /> Monthly Sewer Constr. <br /> �: <br /> Type Permit: • Trunk � <br /> 4 <br /> — Lateral ( <br /> Remarks: t <br /> Abutting Lot Line �� <br /> — N, S, E, W ft. ��: <br /> � <br /> � <br /> 4 <br /> — • S <br /> Approved By �%� i <br /> .__ �ity Engineer <br /> —_ �+i <br /> - —- — Issued By _ � i`; <br /> i� <br /> — i. <br /> Inspection By � cel.��� I <br /> �k, <br /> /�-/^ �� '; <br /> o Date Inspected_ �'; <br /> SEESKETCH ATTACHED N� � I' <br /> i'���SPi-CIIOr! � - � <br /> I <br /> i t <br /> � <br />