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El <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO�0% � <br />T� <br />/c <br />NO. DATE ��f � ef <br />Service Address Utility Account No. r U <br />Billing Address Permit Fee J <br />City, State, Zip / Connection Charge(s) <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Address / Signed <br />'l Curlomer - <br />Dhnn. J % - / i a 0 <br />DESCRIPTION: Sewer District <br />Lot � V Block > <br />Monthly Sewer Service <br />Plat t <br />Unplatted Description Monthly Sewer Constr. <br />Tvoe Permit: 9i , . I I . <br />Remarks: <br />46 <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W, <br />Approved <br />ngineer <br />Issued <br />Inspection <br />Date Inspected 3 /2-'-1I - 8 <br />NO. <br />is <br />