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everett <br />� <br />City oi Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />Nu. DATE �� / _ <br />CHART NO.�-r,� <br />P�, 4'� <br />,,k� �— 7 g <br />/�'-�'- <br />i <br />Service Address ? C'�� � ,r �i� __ - - �i _:� ��ility Account No. <br />Billing Address ' � ��l �i-• - %% _,_ Permit Fee <br />City, State, Zip_ -� /!-'•> .� ���� � ✓�' �yU = ;_ � Connection Charge( <br />Owner (Mortgagor) ' � � � • / ' . Tb'tal Fee__ ____ <br />Billing Name _-�' <br />Connection By � / • C.O __ <br />Address , / � � � -, - � � i <br />i� <br />Phone � - '_ 1 � � <br />I DESCRIPTION: <br />! Lot_ �� Block <br />f � <br />Plat �- '� <br />� Unplatted Description <br />Type Permit: - , _ <br />� <br />. � a ,.��� <br />�. ,..�. ; ' . s .4 �, �,. ��: <br />� . i I <br />, �i <br />t_�- <br />i /U <br />� <br />i <br />Sewer District_L L_ !�_____ <br />Monthly Sewer Service_ _ __ <br />Monthl�� Sewer Constr. <br />T <br />Lateral <br />/ `, <br />Abutting Lut L�ne <br />N, S, E, Vl- --- . i;. -- __ ft. <br />Approved By -- — <br />GIV Enp�neur -- <br />Issued BY.— _ __ _�- --- --- <br />Inspection BY— - -.— _ - ._._ <br />�, � / <br />Date Inspected�_ l _ � <br />��� - <br />,-�_-„.�,. z <br />, � - . ...,in. R.... . " <br />