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r <br />everett <br />� <br />City of Everett <br />S <br />Engineeriny Fii Community ervices <br />Sew�r Applicai'ion and Permit � <br />NO. a_:��;�'_�, DATE ��� - � L— <br />Service Address �'��' �7 Utility Account No. <br />Permit Fee <br />Billing Address <br />City, State, Zip Connection Chargel <br />Owner (Mortgagor) Total Fee <br />Billing �lame_. <br />Cc.�nection By <br />Phone <br />D[SCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />T....� Pormit� � � <br />% <br />Signed <br />Sewer District <br />Block Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />�, <br />— .,. _. U„ <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued BY—' <br />�� <br />'y Enginccr <br />u <br />i <br />� % <br />Inspectiun By� `� '=:•��"'�`Y / <br />Date lnspected ��� - � � � � � <br />N0. <br />Fyyc-y.--r;, t:.;�"4"�-'�'-'.q'r's�,�'.,—:s,',�'�§ �{�:,.� '.._.�� n. . I <br />