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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer A��piication and Permit <br />n� o. s �, `� � �, <br />Service Add <br />_; �i; , <br />DATE <br />-� �� � r/ <br />BillingAddress —= �- ��'� � � — <br />r7' �: �li, `"% ? .;' c�� <br />City, State, Zip'` �- <br />Owner (Mortgagoc). � -�` � � /� !' � `�- <br />' � ��- <br />Biliing Name - — <br />Connection <br />•�� <br />Phone <br />��— <br />DESCRIPTION: <br />Lot —' / Block � <br />Plat � ,_t'i�. �,cL-�.�.� % ( <br />,. / <br />Unplatted Description <br />� � j. <br />— 34—� ( <br />CHART NO!�� � . <br />�' t�„'°:'°'�,��"� � . <br />--... <br />�... <br />j_ /j�—.��:� � ('.(J <br />Utility Account No. <br />r; % <br />Permit Fee �`� <br />' �-- <br />Connection Chargels) S'v <br />��;;. <br />Total Fee_ %� <br />Sign <br />Customer <br />• �L <br />Sewer District � � "''` 'j <br />Monthly Sewer Service "� ' } � <br />Monthly Sewer Constr. <br />Trunk ' ' � <br />4butting Lot Line <br />N, S, E, W <br />) ' <br />Approved By_. -"�. �,<�F�,: _ � .,. <br />City-Engmeer f% <br />Issued By ,�— '"—�—� <br />�. , �' . .Il <br />�. • . � <br />,� r,� • <br />:4< -'.r � "���c <br />�r ei ic� � <br />x:. <br />