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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART N0. �� :: � r '� <br />! �'S � �J <br />N0. ��7�,� DATE �I�- .iv• ��S L <br />0 <br />Service Address � �' U �' �� i �- '..< ,�% • Utility Account No. �'�i�6% <br />// �",P %k'7� /.,�' . �- <br />Billing Address 9 %%�- Permit Fee <br />p ����p�� � <br />City, State, Zip --�-.�-/ E,�7-`��v_i `1 Connection Charge�s) ,`: <br />,ii <br />Owner (Mortgagor) <,�- %'= - .--'-M - Total Fee - - %� <br />Billing <br />Connection Bv _' � �-- ' -. � <br />:. .., .--. �� , _. — � <br />Address `: i G� � Ji+ �r _7`. ::.. . Signed - . t ; .,-r�,;� _., <br />�-. , Customer - <br />Phone ✓ * �l� Y, G��.� ' <br />----�'� � - <�� " `� _ ,�-- <br />DESCRIPTION: , - -'�� Sewer Distnct %=' % .�1L- <br />Lot <br />Plat <br />Unp <br />Type Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />'�lonthly Sewer Service ~ f <br />Monthly Sewer Constr. <br />� <br />Latera I <br />Abutting Lot1.iqe / <br />N, 5���!�N ' '� ft. <br />- f" �/ . <br />Approved By ' �"' <br />City Enpineer . <br />Issued By -� � <br />c�/%, 1 <br />Inspection By j�J <br />Date I nspected �� - / y ���_ <br />N0. _ ' �. _. <br />�i' 'St���'i'i"e �Z K� i�., i <br />� a a ��'[�t�.`7l� �b�n( ��y S Ybid . .i <br />