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� everett <br />I � <br />� City o( Everett <br />� Engineering & Communiry Services <br />i <br />; Sewer Application and Permit <br />� <br />i <br />� <br />u <br />i SE�: SKETCH ATTACHED <br />��r.1:;:;'�.'_. , .�T"�`�"�K'�: <br />NO. ,' DATE _ f�_• i / � <br />Service Address ����' /'� �� � <br />Billing Address_ �--- <br />CitY, State, 2ip ' .�� - �� -. ' � <br />Owner (Mortgagor) � � __ <br />Billing Name / <br />Connection By � <br />CH,4RT NQ�$' � <br />, <br />�---- -_ - <br />Utility Account No. — �'> � ' :��� <br />Permit Fee J'% �� <br />Connection Chargels) <br />_ ., � � <br />Tot�il Fee_ ' __ . — . - ,-- <br />Siyn�!d_.__ . <br />� o��.���� �„ � -___ _ _— _. <br />Phone � � .' �� ��� -- - <br />DESCRIPTION: Sewcr Disuict <br />Lot_ Block <br />Plat �,.� �'E/ %�/ � Monthly Sewei oervicc <br />Unplatled Descriptior _ .: 'Y • � �; r'�' ,:f. Monthly Sewer Constr. <br />Type PermiL � i -� Trunk__ <br />� . - v <br />—� Lateral___ __ <br />Rem„rks: <br />i <br />Abutting Lot Line <br />h'. �, E, W_ <br />�.i,riu�;i�lity-- . -- <br />i:�iv _����n�.,.,-- - � <br />Issued 8y_"` ' _______ � <br />-Jt. <br />7— <br />Inspection Dy_�i�� � r- - <br />/ <br />Datelnspected � ���1 i S� <br />/ <br />vo <br />�'";!'��(���+�;�,Jt� . <br />I :+r:(�4� af� i:`,�R{u 1Y r�li�., l ,�:r!:. <br />