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everetl <br />e <br />City of Everett <br />Engincering & Community Services <br />Sewer Application and Permit <br />N0. i�.i_:__�;�rj DATE y' %�' �� <br />- c � / ��—� <br />Service Address � �4 � -''✓-'-� �'�--� / <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) ��-, �i '���.�-r :, �'� f <br />Billing Name <br />�� <br />Connection By � � � - T -'.F . . � /' -t <br />.. . <br />Address_ 5 /0 -< <br />DESCRIPTION: <br />Lot <br />Plat <br />I � A <br />r, 7 � � > ' <br />Block <br />CHART N0. ���"L+�?9'� � <br />/7cSTct'.t�' �._. <br />�,. <br />Utility Account No. <br />Permit Fee �U �' <br />Connection Charge�s) <br />Total Fee <br />,�U �i� <br />Signed <br />Customer <br />Sewer <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />� WSPECl�I(1N <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />�.-.. _ � . <br />4pproved By�, �� ,-. <br />City Eneineer <br />r <br />i <br />ssued BY' r` " —�` % <br />nspection By_�-���-�+ — <br />)atelnspected � _ <br />NO. <br />