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evereti <br />e <br />City of Everett <br />Engineering & Commur�ity Services <br />Sewer Appliccstion anc� Permif <br />,, �,�/�� <br />N0. �� ��. i �;: �i DATE � , � <br />CHART NO.�/��-�'� =� <br />, ,,� ',� <br />� __ � i '- <br />Service Address��� �-��'"� ���� � y� Utility Account No. <br />/: ;,. . /r�� �„ :�SDy ��� PermitFee �`—•'�'+n..�� <br />Bifling Address � <br />z . ;.;., i <br />City, State, Zip ��/��� �'' -- ��_, Connection Charye(s) <br />pwner (Mortgagor) <br />� : 1-1 l-> �. �..�-ti �;...ifc� � Total Fee— ��-.i f �,.i � <br />Billing Name ���-��� ��=-7�-� ��� ' <br />4 • � V�' �\/�--G �f--=7J <br />Connection By <br />DESCRIPTION: <br />� c <br />Lot � � - � � Block '=--�-"' I <br />Plat �_ .ir=-t'.�TT {"�' . <br />Unplatted Description <br />Signed � �,... � L �-..,.,�'_c:"_,`•_;_ J>.� i �: <br />Cusiomer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />SEE SKETCH ATTACHED "'� <br />. • ;'± ,' �*�' . <br />.:vl, �'f°� � �a k � ''_ <br />�. <br />Approved By ��'� N/i i�� L <br />' Ciry Engineer <br />IssuedBy � �_c>c_�..r:i�,..,.J <br />Inspection By�S�-'-�---�"'�� <br />Date Inspected�._J- 7ti' <br />N0. <br />�e�� � �'�� .t.i � `'. <br />;.�'� r":+ ��..i.p <br />