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everett <br />� <br />City of Everett <br />Eny�neering & Community Services <br />Sewer Application and Permit <br />, .. .. � ; � - /�- ! ✓ <br />NO. ��_;;;�� DATE <br />Service Address ' '� �/ - � � ' <br />�, i r; � . . , ✓ i�-:�:� <br />Billing Address � <br />City, State, Zip � �� ' `1 � � � — <br />Owner (Mortgagor) -J <br />Billing Name � `-� <br />Connection By "" __ <br />I Phone -' _ � �� �' �� <br />� <br />i4 DESCRIPT19N: <br />I' Lot Block � ' <br />Plat / /" i" r,, <br />EUnplatted Description <br />Type f'ermit: ' � ._ _ �_ <br />CHART NO�� �� �' <br />i�� =� � �� J <br />� ' -., <br />�� <br />' ! <br />Utility Account No. <br />r, �_ -�� <br />Permit Fee � — <br />Connection Charqels) <br />Total Fee � `�� '������� <br />' `� � C � �`z�-""""- <br />Signed � `". ` � <br />Cuswmer <br />Sewer District_ '� <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />- -f <br />_1� <br />-� '` � <br />; <br />�. . , �:i <br />/0 <br />Approved By � ' �� / ' ' ' <br />City Enginecr , <br />Issued By ' ' . - � — <br />Inspection By �� -/��'�u-�-�" <br />Date Inspected 9/fL�7 <br />i� <br />N0. _ _ <br />•��--��� ^g� t �';; <br />. <br />. .. ` ._. . _ _ ___. . . --•w-';'y�'�'�'°. <br />