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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. `�,";r'J .�'TE I�% �'I <br />Service Address= ' � -� U - � ' ' % 4 _ j- <br />Bil�iny Address <br />City, State, Zip <br />Owner (Mortgayor) _ <br />Billing Narcie <br />Connection By i_.v.•'�� ' ' %% <br />,: <br />Arlrirrcc / �/ � � <br />Phone <br />CESCRIPTION: <br />Lot '/ � /D Block r � .� <br />Plat /' � � <br />Unplatt�d Description __ <br />Type Permit: : -�C..,.y,. � <br />Remarks: <br />0 <br />N <br />SEE SKETCH ATTACHED <br />f'� _ . , . "f';�.; ���.ti <br />� .. . . . . . _ ,.+ ;_ <br />CNART NO.V"ZG 2q'�S� <br />r o S f�--�� .�a <br />/Z - .Z z.-?� <br />I�e'J�.�C! <br />Utility Account No. � <br />Permit Pee__ �'" <br />Connection Charge�)%� <br />Total Fee <br />Signed � ;' <br />Custamer — <br />Sewer District <br />Monthly Sewer Service <br />_ Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />�--- N, S, E, IN_ <br />�h lc.�' <br />--� Approved By� <br />Gry Enginrer � <br />/. . <br />-- Issued 8y='=____.-__� <br />/,1 <br />_ Inspection By � � .J�� <-+��,n�-Ll �/ <br />Date Inspected ��9 — 7 � _ <br />� <br />N0. <br />U`JiI 6Cil[?f <br />. <br />::, � �.-t��. <br />.. . . _ .. ., _...._ _ .:x::� .. _ . <br />