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n . , ''� <br />everett <br />e <br />Ciry of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />DATE �� � <br />� �. ''��. ;,✓. _ , . <br />�� <br />CHART N0. r�"Z� _ <br />�-aS- % C � <br />�_��;_� � <br />.- � <br />Service Address '•� ���' �- f J���ltility Account No. -_ <br />Billing Address - ' ' v �� > >~��� � � � ' Permit Fee __ <br />i ; ._ <br />City, State, Zip %. -�� G.it; Connection Charge�s�_ <br />% �. � <br />Owner (Mortgagor) � ' ' •� Jotal Fee <br />Billing Na <br />Connection <br />Signed <br />/l %- f ��,, '. <br />Phone — <br />9 �S <br />i <br />-- �_ :i <br />�.— <br />DESCRIPTION: Sewer District � � <br />Lot �� Block - Monthly Sewer Service. <br />Plat -- J <br />Unplatted Description_� Monthly Sewer Con ,tr. <br />— Trunk <br />Type Permit: <br />LlomnrLe• <br />SEE SKETCH ATTACHED <br />��� <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />%1! <br />; "i <br />Approved 8p ':¢� --- — <br />Ciry Engineer <br />Iss�ed 8y ^ . ( <br />Inspection By <br />/// � �'>�—i <br />Date Inspected_ � � — <br />N0. <br />, <br />i <br />