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eW <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. 2215 S DATE_ — <br />CHART NO,d <br />Ql� <br />Service Address i r ' � I ) e. Utility Account No.. <br />Billing Address_ I I 'r �(� r 1 — Permit Fee__ <br />City, State, Zip { f ^ It ConnectionCharge(s) <br />Owner (Mortgagor) Total Fee / <br />r — <br />Billing Name .2/\/ <br />Connection By <br />Address <br />Phone- 3S J 7 7 / <br />DESCRIPTION: <br />Lot <br />Plat _ <- <br />Unplatted Descr <br />Signed_ <=% <br />Customer <br />Sewer District (r 1L <br />Block <br />Monthly Sewer Service <br />Monthly Sewer Constr, <br />Type Permit: ! /4 , , , . <br />Remarks: <br />0 <br />SEE SKETCH ATTACHED <br />;rra ; t i i� r• <br />Trunk <br />Lateral — - <br />Abutting Lot Line <br />N, S, E, W ft. <br />i <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By <br />i <br />Date Inspected. <br />NO. 1 . <br />1 <br />