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everett <br />�e <br />City of Everett <br />Engineer;ng & Community Services <br />Sewer Application and Permit <br />NO. <br />DATE I (i / / f- <br />CHART NOD -I 7 "'2�C <br />I I� <br />7� <br />Service Address__ - (_ _ Utility Account No. 't ' <br />Billing Address Permit Fee <br />City, State, Zip Connection Charge(s) <br />Owner (Mortgagor) ,- L0 At, p Total Fee <br />BilliagName Jx'I•-•'r - <br />I <br />Connection By <br />i <br />Address Signed <br />.� J customer ` <br />Phone _ <br />I <br />DESCRIPTION: Sewer District <br />i <br />Lot! `' _ Block <br />Plat 1 i,.'E t 4- 1 c i, i r_ t, /"/. v : r r_ Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Trunk <br />Type Permit: A/(. it ,t,_'� c ,- ; • .. <br />u C.. <br />e <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />N, S, E, W ft. <br />SEE SKETCH ATTACHED <br />Approved By /. <br />City Engineer <br />Issued By �uD <br />Inspection By —A - <br />Date Date Inspected I 3`D / d <br />NO. r_c_J"L- <br />