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I <br />evereu <br />e <br />City of Everett <br />Engineering & Community Services <br />Sever Application and Permit <br />N0. 219. DATE IG/Z' `-7Z <br />Service Address_ <br />Billing Address <br />City, State, Zip <br />CHART NO.�z Z� -� <br />/'�7s• i� <br />Utility Account No <br />Permit <br />Connection Charge(s) <br />Owner (Mortgagor)__ _ Total Fee <br />Billing Name <br />r <br />Connection By <br />Address _ _ Signed ' <br />cu510mef <br />Phone - <br />9. CRIPTION: Sewer District <br />lot• Block <br />Plat Monthly Sewer Service <br />Unplatted Descriptidn Monthly Sewer Constr <br />Type Permit: <br />Remarks:y_t�L/ <br />X1, rX <br />Y — - <br />SEE SKETCH ATTACHED <br />I <br />Trunk <br />Lateral <br />,Abutting Lot Line <br />N, S, E, W <br />Approved <br />Cnv <br />Issued B <br />Inspection by (41i4i <br />Date Inspected 16 - J G - y7 <br />NO. <br />t <br />