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everett . <br />� <br />City of Everett <br />Engineering & Community Services <br />S��nrer Application and Permit <br />� <br />N0. ._ .' `, : ': .� DATE ��' �"! <br />Service Address J � <br />Billing Address � ��'� — '� -� ' � = � <br />� � <br />City, State, Zip ' � : %'; : � - �% � <br />i --- . <br />Owner (Mortgagor) � ' � " - ' � � <br />Billing Name <br />Connection <br />Address <br />' � -- : — -- � i ; <br />DESCRIPTION: <br />Lot > � � � Block � <br />Plat ' . <br />Unplaited Description <br />Tvne Permit: �.�%�. � � . . '. <br />CHART N0. �-� � �" �� � — <br />�) J � � / � <br />�-. <br />z-�� "� <br />4�r/ � <br />; <br />Utility Account No. <br />.: J _,:..- <br />Permit Fee J <br />�� <br />Connection Charqe(sl ^ <br />Total Fee __ <br />.. <br /><� <br />Signed ���% (/ <br />� COstomrr - <br />SEE SI<ETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N � S � E � ����---- <br />Approved By - <br />c��v�E�,� �.-� <br />Issued Bv r' <br />ft. <br />� � <br />Inspection By G 24�L+-✓ _ <br />Date I nspected O ^ � � � � �' __ <br />� , .:_ __-. ,, ; _ <br />.. _ . ---- ��� <br />N0. <br />