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i <br />� everett <br />i �� <br />� City of Everett <br />� ' Engineerinc� & Community Services <br />i Sewer Applicatinn and Permit <br />� <br />NO. ,_ , . DATE <br />Service Address - _ _ <br />Billing Address_ � _ <br />City, State, Zip ' _____--� <br />Owner jMortgagorl_ - <br />Billing Name ' � �, �. — <br />Connection By " ^ � � <br />C H A R T N 0. T���4 �-- <br />�� S ��d <br />2.-�_ig <br />�/ <br />� <br />Utility Account No. --- --- <br />:� <br />Permi[ f-ee — <br />_l� <br />Connection Chargels) ��'�' -- <br />_..� <br />Total Fee--- __._ __ ---- --- ---------- <br />Signed — -- <br />Customer <br />�/—� � <br />Phone --- <br />DESCRIPTION: Sewer District_� - ---�---- <br />Lot �.'' 91ack �� ;; -�i , ,, ... . � Monthly Sewer Service _— --- --- <br />Plat --�r � -`--`v-+-. ., t� ) <br />Unplatted Descr ption'----------- --� Monthly Sewer Constr. <br />Trunk ' ' -_— <br />Lateral � � <br />^`,,;. r:. ° �:,.' i�u �_. -_�..� <br />' . <br />,, <br />Abutting Lot Line <br />N, S, E, W. <br />APProvr.d f3y <br />iy <br />Issued B <br />r"' <br />it. <br />/� �� <br />Inspection By 'lL �" � 1=���- - ' <br />Date lnspected � a � � �� - - <br />N0. <br />, ; <br />'�'�^� ��,�._ s...' n "':.;..:.., f�tr_. .�..�' . �.:;. .. � ,...;�.. <br />