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evere" <br />,,e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 2 18 j DATE i!' <br />Service Address !J <br />Billing Address <br />City, State, Zip, lUy' %-ilia <br />Owner (Mortgagor) --� <br />Billing Name <br />Connection By — <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />CHART NO. <br />Utility Account Igo. <br />G <br />Permit Fee_ V <br />Connection Charge(s) <br />0.�' <br />..xotal Fee_ 30 <br />Signed -r <br />4 <br />Sewer District - J <br />Monthly Sewer Service d <br />Unple!ted Description ' sf ��/ % ^ ^ Monthly Sewer Constr. <br />•! a P S Trunk <br />Type Permit: .;'Kxy Cer.�-.tee s <br />Lateral <br />Remarks: Abutting Lot Line <br />N, S, E, W <br />— -- Approved By <br />Cily -9-11. ' • <br />Issued By ' 4 <br />Inspection By --A <br />Date Inspected---�p 77 <br />a ' <br />SEE SKETCH ATTACHED, NO. <br />