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��«�n <br />� �� <br />City of Everett <br />Engineering & Community Services <br />S�wer Application and Permit <br />N0. _ , . DATE � �/r,l �i:i <br />i <br />Service Address_ " �� ^ J - J �"" " <br />i <br />Billing Address ' � fc� ��� %/� ,� <- - <br />- r,/ <br />City, State, Zip / -:it. ��� ^ �' <br />Owner (Mortgagor) � � � � _ <br />Billing Name. �--� _ <br />Connection By_ - <br />Phone_ � ��' �.� �� <br />DESCRIPTION: �/ <br />Lot � k- / �- Block �T <br />Plat /` ' • J. �c=r'� . <br />Unplatted DescriKition <br />Type Permit: f , � ' , ,� <br />Remarks: <br />� . � .-, <br />CHARTNO. '��"_._ <br />� <br />; �� , <br />�'.�',1� i <br />? _��, <br />�— _ -- - -- - ---- <br />Utility Account No. - <br />;,'/ <br />Permit Fee �!� <br />Connection Charge�s)_��� <br />T�ot�il Fi�c— — - .. - <br />Signed�:__ <br />cunan"� <br />SEESKETCH ATTACHED <br />>„�,. -�; ,,. � <br />_,,...�,�y,�,�^-„._ - - . _ .� _ <br />$CWP.f �IStfICt___ <br />Nionthly Sewer Ser:�irc <br />Monthly Sewer Coi:str. <br />Trunk____ __ <br />Lateral <br />Abutting Lot Line <br />, - , G . '. :' _ . <br />Approved f�y_ . <br />c ,. , <br />Issued <br />c <br />Inspection By - � ��"�- <br />Date lnspected /� �� �,�� __ <br />N0. <br />� _ � ` <br />