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�_ � r <br />ev�relt <br />�� <br />� <br />City of Everett <br />Enr�ineering & Comrrunity Ser✓ices <br />�ewer e4p�alication and Permit <br />NO. - - �' _ / DATE %�:% - � � ._. / �i <br />Service Address � - ��' % �' / <br />/ <br />BillingAddress ' � � <br />City, State, Zip _ <br />Owner (Mortgagor) _ <br />Billing Name ____ <br />Connection By <br />0 <br />DESCRIPTION: <br />Lot�'? plock <br />Plat <br />Unplatted Description <br />Type Permit: . <br />� �. <br />CHART NO�'� .� " _n • �ST t <br />r ) ; <br />� �� �� � � <br />v� ;I <br />�.�� �� � ��' . i <br />c�/� ; <br />r <br />; <br />. � <br />i <br />Utility Account No. ' <br />Permit Fee � <br />Connection Charge(s) -� " J <br />; �.�-- , i <br />Total Fee I <br />1 <br />-% ; <br />� �. ': j , <br />Signed [ I i -�-r �" :'" <br />" ' Customer � '', <br />Sewer District ' <br />Nfonthly Sewer Service_ i� � <br />_ Monthly Sewer Constr. � <br />— Trunk � � � � ' <br />i <br />Lateral �'� i <br />SEE SI<ETCH ATTACHED <br />_ --- — i ' :'� r � i ' <br />Abutting Lot Line <br />N, S, E, W, <br />,. � <br />Approved By <br />City Enqincer <br />IssuedBy � ' --__ <br />Inspectior� B ` -i�r�� <br />Date Inspectedla � �' %�_ <br />N0. <br />