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everett <br />� <br />City of Everett <br />Engineeriny & Cor;ununity Services <br />Sewer Application and Permit <br />tio. 22395 DATE <br />Service Address � - '� <br />Ciilliny Address <br />City, State, Zip �" . '" I : <br />Uwner (Mortgagor) _ <br />Billiny Name <br />Connection Eiv --- --- --- <br />i�f1011C__ <br />DESCRIPTION: <br />Lot --=---- .; <br />Plat .-------- <br />Unplatted Descripti <br />Type PermiC <br />Block <br />cHARr ri <br />Utility Account No. __ <br />Permit Fee �, <br />Connection Charye�s) __ <br />,� <br />Total Fee r�_ <br />,I <br />%'. ' f �`�^ , '' f ,,�� <br />Sign�dfc'C�r.i �" /'( `�.jr.,_,_._._Lj�i� — <br />Custoine� <br />SEE SKFTL'H ATTL�CHED <br />_ _ ; , �.. ..,.,,,, <br />INSPL"CTI�iN <br />Suv,�er District_____ <br />Munihly Sewer Service__. <br />Monthly Sewer Coristr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W _. <br />APproved By <br />Ci1V Lnyinrrr <br />Issued BY-----------= ._- — ----- <br />InspecLon 13y.._ _. __ _____ _-- -- -. . <br />Date inspectcd-- __ . . _ _-- ._ <br />;.�.. <br />N(1. � . .. . i <br />_. ' .._ ..�..� <br />