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� <br />evere., <br />; <br />�i;y of Everett <br />; Engineering & Community Services <br />; Se�nrer Appiicatioi� and Permit <br />N0. n-' t� ::l DATE `� l- ' <br />Service Addres�-1 - �'� � %/ : <br />Billing Address l"' �`' ' ' �� <br />City, State, Zip % �,v✓ �.° - ='� <br />Owner (Mortgagor) - �< <— " <br />Billing Name <br />Connection <br />Phone_ <br />DESCRIPTION: <br />Lor � <br />Plat <br />Unplatted Descr <br />, Type Permit <br />i _ �: <br />_ Black <br />- � .., <br />v., .;, <br />iption <br />%:'., _ , <br />CHART NO�� '�y' 2r�S - •- <br />I�O$ �� � <br />l/ - /.� - ? � <br />10��'�,r' � • <br />Utility Account No. :� ''<'-`- �' '' <br />� <br />Permit Fee � ' � <br />Connection Charge(s) - � <br />Total Fee_ �� <br />�igned <br />Customcr <br />SEE SKETCH ATTACHED <br />�-- -- ,- <br />_ _...-----__.T. _--_ _ <br />Sewer District � ' �<!� <br />Mon?hly Sewer Service "� t� <br />Monthly Sewer Constr. <br />Trunk =":� <br />Latera <br />Abutting Lot Lin� <br />N, S, E, W, <br />Approved By � <br />Ciry Engineer . <br />Issued B <br />r <br />. '/, .._-. <br />Inspection Dy -'f ''-1.(%L�i''1����� <br />Date I ns?ected ��/'� �/7 �� <br />/ ' <br />N0. _ <br />� _ ,_- �.,.�... <br />