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everett . <br />� <br />City of Everett <br />. <br />Sewer Application and Permit <br />� 23636 oATE � , ,- ,- � � � : <br />NC.. <br />CHART N0. L 6 -7$-S _. <br />. <br />;�� �.-��� � �;� 3 -16 -�3 i <br />Service Address ��' �� � �!%'�'�N'Q � Utility Account No. %'-'� � �'�� ' O <br />( � l�' ::,; 1 ��..1_.1-: � ��... � � Permit Fee -- _�C.� � S,. _: <br />Billing Address �- — <br />City, State, Zip l_t �Lr � �: i.�. �i � �i: .�:C?-'. <br />�- <br />�--- �j , <br />Owner (Mortgagor)�% ' ' � � � r��� � <br />�� �r,� , , <br />Billing Namc✓J�it � � - <br />Con�ection By - ' ' <br />Address ` -�+ t c �_._.. _ �, <br />_ � _._ ' � '� �.{ <br />DESCRIPTION: <br />Lot ' ' Block L'� <br />! ;�` .r .. <br />Plat :_ e.._/�. ..:.� �- ! 1 � 4�1 � <br />Unplatted Description <br />Connection Charge�s) <br />.. {', '�: <br />Total Fee '_.1._J <br />Signed*' ____ <br />customer <br />Sewer District � - �-'"'�� � ^ <br />Monthiy Sewer <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />P,butting Lot �ina <br />N, S, E, W, <br />APProvea By � _ . �. � � _ ; � t__ <br />City Engineer <br />� (` � �.`i,_� � {-; v�,�,/ <br />Issued By.. - ' ' <br />Inspection B � !� <br />Date I nspected � J � �� <br />No. 23836 <br />