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everett <br />,.e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. '2 L J. , j 8 DATE —,7 � -- <br />Service Address— <br />Billing Address l(L G cl' �Tr, t.- NAC — <br />City, State, Zip <br />N/16 w �1,._1. t \r 1, . 7! <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />'� <br />CHART N W3° �_- <br />Utility Account No. — ! `' t ` t <br />,_.f t't <br />Permit Fee — <br />Connection Charge(s)_ <br />t Lt <br />Total Fee__ — <br />rA- <br />Address �t C t L "( rt . l\�.: r_ ti l_ _ Signed _•✓ <br />Customer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot L4, Block— Monthly Sewer Service <br />Plat ✓r..,t:l_ !>t,t ''Iti1 <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit: ��� _._w L ( � . ; , t ,%_, _ <br />Remarks: <br />SEE SKETCH ATTACHED <br />Trunk L C) <br />Abutting Lot Line <br />N, S, E, W <br />Approved By L I It_,. t t i 1{ <br />City Engineer <br />Issued By <br />Inspection By <br />Date Inspected��s —_ <br />NO. <br />