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Iev <br />el <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. �" ! �, A DATE <br />CHART NO."To �$t� <br />Service Address 7_ Utility Account No. <br />Billing Address P0. / /_ / Pfrmit Fee <br />City, State, Zip ! ' /? - % Connection Charge(s) - o <br />Uv <br />Owner (Mortgagor) - Total Fee U <br />Billing Na <br />Connection <br />M. <br />Phone J e <br />DESCRIPTION: <br />Lot _��� __ Block <br />Plat <br />Unplatted Descriptinn <br />1 ype Permit: /jZ". , <br />Remarks: <br />SEE SKETCH ATTACHED <br />i . I , 1 1 <br />Signed <br />Cutromer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk =' <br />Abutting I_ot Line <br />N, S, E, W <br />Approved By <br />cay Engineer <br />Issued By �r ' <br />Inspection By <br />Date Inspected l7 <br />NO. <br />i <br />