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, <br />everett <br />� <br />City of Everett <br />Engineeri,ig & Community Services <br />JV's <br />,� <br />�/-2_— <br />� �_,�- '7 <br />Sewer Application and Permit <br />NO. �� �_ � � E���to DATE �: :i U - <br />� �J: <br />Service Address � — <br />J� ,� <br />Billing Address_ � E �� � ,%' ' <br />City, State, Zip •' .r ' � ./Gr: ✓�/,f�_�'J <br />-� / - �. <br />Owner (Mortgagor) � ��" - <br />Bil!ing Name � .— <br />Connection By_ !��` ° i— <br />Address — <br />Phone 5•`' 3— v-' l"` <br />DESCRIPTION: <br />Lot � � Block � <br />Plat :% •�:' ✓ <br />CHART NO.G.�i��'" � "'"i�-- <br />. � <br />�o S �G � <br />� -- l 5 - 7� <br />�3�' <br />Util��y Account No. %- �� �" ' ���f� U � <br />., ,�• <br />Permit Fee � =' <br />�.%' <br />Connection Charge(s) `'> `� � <br />- °i� <br />Total Fee %�% <br />/ , //'' � � r/ / /' : _. � <br />, �/ /� / <br />Signed ''��-''i''LS� ✓l ,'t„H / —`_ <br />.�j Custamer � <br />� <br />,'i <br />Sewer District %� �, -�" <br />Mo�thly Sewer Service " � <br />f <br />Unplatted Descriptiorl Monthly Sewer Constr. <br />'' i <br />Trunk t`�� �� � �' <br />_� i ,. <br />Lateral .= i :�'ir ; �=' S <br />T....e Pormit� . . . . , . <br />Abutting Lot �.ine / <br />N g,GE,?�,�r �/'� ft. <br />�i� � � � <br />Approved By ,..'` ''�.=.. < <br />City Enginear / <br />Issued By �` - <br />. • . .t. ��.� <br />�. - .• •. <br />� <br />, P. <br />��� a .i'� }�.n i �, i � i, <br />'_.1 Y"" ` a.v'.�' W t'y .i �.... <br />I <br />F <br />