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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 21 ii 0 DATE l f 1/7 <br />Service Address 0 '-, r,'c S <br />Bi!ling Address g '/V '1 — rw G^ <br />City, State, Zip j -7 w ik u <br />Owner (Mortgagor) l *� D <br />Billing Name �< — <br />Connection By - — <br />Phone 3 , 3 - 3 u " - <br />DESCRIPTION: <br />Lot _ Block <br />Plat <br />Unplatted Description <br />CHART NO.�' <br />Utility Account No. -> ' -3 f - / el- 0O <br />Permit Fee_ <br />30 <br />ate-- 7 7 <br />Connection Charge(s) Y of <br />�y <br />Total Fee -3 O <br />�---- - <br />Signed__ <br />�.•Cunamer <br />Type Permit:%4s.� i,� » N �.r.f=.✓ — — <br />Remarks: <br />Sewer District .3 4 � <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />y` <br />Trunk_ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />— -- Approved Br — <br />City Engmee, <br />i <br />- -- Issued ey C' y'-- <br />SEE SKETCH ATTACHED <br />.emu <br />Inspection By Date Inspected <br />Inspected <br />NO. <br />I <br />It <br />`tit`/'M'f+r�1VskId, 6\tl <br />