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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer qpplication and Permit <br />N0. � ? �� : � DA7E <br />�' �� � <br />-,: _ J i <br />Utility Account No. '� ` �' �' ��' " <br />Permit Fee '�' J . i : ;.: <br />.� :r�- , I <br />� i <br />� � � '. .t Y 'l i `1 _ � <br />Connection Chargels) i <br />, <-� 1 <br />i :r <br />Total Fee � <br />i <br />I <br />CHART N0. �`� ' � �� <br />;�s� c1) <br />� -z1-79 <br />�%S <br />;_# 1 � ' � i i:.�_ . <br />Service Address_r �� <br />Billing Address � % '�� %" '" "` � �' <br />' :;�,i <br />� . <br />City, State, Zip ��-'�7% `� '" .� '`i % :.r=' y <br />Owner (Mortgagor) ��� r`�. ..� ) _ f; . ,. . <br />Billin� Name - <br />Connection By ^} . .�.� 1. , � _ )_.:..�-. , <br />� / �� � �� �^ <br />Address � <br />Phone.� � i - "'' S 7- '`— <br />DESCRIPTION: <br />Lot — Block - <br />Plat — <br />Unplatted <br />i <br />Signed Customcr <br />Sewer District � <br />Mon[hly Sewe� <br />Monthly Sewcr Constr. <br />SEE SKETCH ATTACHED <br />.,k . �. . ..' � .. .� .I i X ,`�` $�. <br />INiPCC-ilQi��: <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />Approved BY ',��"'"' , <br />Ciry Enginuer _ <br />/ <br />'� i. <br />Issued By `_— � �" <br />Inspection By � � <br />Date Inspected � - l �— ��� <br />N O. � "i <br />,� . µ ��;,,�r��,� i., . <br />lu�"�'—�'�.a42'� J�ry. ,v�iv1+ r+.4C��3.�"A���'��,: , <br />