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everett <br />� ' <br />� <br />City o( Everett <br />Engineering & Community Services <br />Sewer Application ond Permit <br />NO. <br />DATE �-- �,/, <br />, i � <br />i <br />Servic Address � �� p // ��li j� _-�.,, . <br />BillinyAddress /r�=' �i � �" —� <br />' CitY. State, 2ip_ .s �' , %i . / /+'/ )'� <br />Owner (Mortgagor� � • �� <br />, Billing Name <br />Connection B <br />Address <br />PhOne_ ��� - / ;• U � __ <br />��.ii <br />�1 � <br />CHART NO. � `' ."- `}_; <br />. '`- c� r . c\' 7 , <br />��� c�/��5� - <br />�� <br />Utility Account No.__ <br />, i�j: <br />Permit Fee � ' � (� <br />vG <br />Connection Charge�s) " /'' � <br />„� ' <br />1'otal Fee �. / ��� <br />. , <br />t � `� 1 � �- , � <br />Signed %J ( � � , <br />customer - _ <br />DESCRIPTION: Sewer District % <br />Lot _ Block <br />Plat _ - , Mon[hlv Sewer Service <br />Unp�atted Description � .. / f � Monthly Sewer Constr. <br />�- � t � �'I, <br />� <br />Type Permit' ' _, — Trunk <br />.� <br />i ,� �� _ � .._ . — w .,I _. <br />�. :. <br />Remarks: / • <br />Hnqineering has performed all inspectione and <br />should provide asbuilts <br />6/20/7B <br />a------- <br />; SEE SKETCH ATTACHED <br />i <br />Lati�ral <br />Abutting Lot i.ine ? , , <br />N. S, E, W I� .� a------ft. <br />Approved By '� • <br />CnV Enpmeer . -- <br />Issued B <br />Inspection <br />Datel�spected <br />N0. <br />� �� <br />