Laserfiche WebLink
u <br />h� <br />xr.�.- f^ ..t.... . <br />� � fi, <br />everett �'1 <br />� <br />e <br />City of Everett <br />Cngineering & Community Services <br />Se�wer App�ieation and l�ermit <br />N0. ;' � 1 :;; M. DATE <br />Service Address �' � � - � ' � <br />� <br />Billing Address "' <br />City, State, Zip � ` � <br />Owner (Mortgagor) ' ' � <br />Billing Name ' � " ` ' � ` ° ' ' <br />Connection By ' <br />Address � �' ' ' <br />1 ( <br />DESCRIPTION: <br />Lot Block <br />Plat <br />,� r' ._ <br />Unplatted Description <br />�;HART N0. � � � � <br />I �'°.��-�= � <br />�_��_�� <br />�� <br />Utility Account Na. " ��' � ` r <br />� c. <br />Permit Fee - � <br />Connection Charge�s) � � � +` � . ' ', J ' /� �� � <br />t'c. <br />Total Fee - �'' <br />` �f /_1' �`, � �/' I <br />Signed �, !r�-•e,�=-tY •. �." � tJt�-�.,.r._ <br />Customer <br />Sewer District � `�� � <br />Monthly Sewer Service '' � 'i � ` � <br />Monthly Sewer Constr. ' <br />. . � <br />, . �, ,;,r;.,: <br />r, <br />� <br />ar ,y <br />,i�' .-''�t3h _S. ��1. t. �.u,"i'+w � <br />Lateral ` ' <br />Abutting Lot Line - <br />N,,S, E, W ' �' ... <br />Apprc i gy ` '��; ,;, ; ,,..- <br />City Engineer <br />IssuedBy � ;:" �,i i i�i:��i_,.� <br />< <br />Inspection By � � ' �'r�Lw— <br />�/s�/�� <br />Datelnspected � <br />�, �� ,. <br />NO. __: ._... <br />r �< � <br />� <br />� .:t�•. ..��v. <br />