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� r.HaRr No. ' <br /> everett <br /> � <br /> City �f Fverett <br /> Se�r�r Ap�alication �nd Per�it � <br /> IVO. 2��7y DATE ' ( _ <br /> Servir.e Address .__ ' -- Utility Account No. <br /> Billing Address _ Permit Fee _ <br /> City, State, Zip � Connection Charge(s) _ _ <br /> Owner (Mortgagor) � , Total Fee <br /> Billing Name -' ' i <br /> ConncctionBy' '`.J • � : ; . <br /> Address '_f <- ' %:� � � Signed _ <br /> Customcr <br /> Phone I <br /> I <br /> DESCRIPTION: Sewer District__ <br /> Lot ! '� Block � <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer �onstr. <br /> Type Permit: , Trunk____ � <br /> I <br /> Lateral_ � <br /> Renarks: � <br /> Abutting Lot Line � <br /> _ N, S. �, W- --------- f L i <br /> I <br /> i <br /> I <br /> - ---- Appraved 6Y —_---- I <br /> aro e��i����•�:� <br /> � <br /> - Issued BY-- --- - ----- � <br /> - i <br /> _ � / r � <br /> Inspection By <br /> - -----_- ----__-- - _.-- --- Date I nspected � /Y L� � `7 `�__ I <br /> SEE SKETCH ATTACHED No. 2.3370 <br />