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��i,r. ,, c'�.�:'.- � -z �J <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />; Sewer Application and Permit <br />CHART NO.� ��' = � ' ��� <br />, ' L-� <br />,>=,� , ��- � �%�/� �� <br />/�, L�', N0. [ I_ ;, ., �'': DATE ���� � <br />Service Address �'— �'f� �' Utility Account No. <br />� <br />Permit <br />City,State,Zip / �, l%fU ���—�G� ConnectionChargel <br />/� / �/ <br />Ov,mer (Mortgagor) /`'r -,2�.� . C:_/'��—, • � Total F <br />Billing Name ' — `� <br />! <br />Connection Bv � �'' ' "/'`/''{� ' � ` � <br />Address �yU / k �'� �j• F^• Signed <br />�c , i '� � ��,.- :Gr< _ > i..� .: 3 <br />% ' <br />Phone_ L ��yO j <br />/ J �� <br />,�N. Sewer District <br />� <br />DESCRIPT� . e <br />j Lot �`�' �� Block ��A Monthly Sewer Service <br />� Plat " ' � - <br />I d D ' tion Monthly Sewer Constr. <br />Unp atte escrip <br />Trunk __ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W__— <br />Approved By ' <br />Ciry Enyinecr <br />�SSUCdBY� --_—__ <br />Inspect;on By_� �� '��6-.�—� <br />Datelnspected 3 -- <br />NO. <br />�t � <br />� <br />