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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permi� <br />�. , �, •� /cJ - !i- - 7 � <br />NO. �_ !_ � u �_ DATE <br />Service Address / � � ' "' <br />Billing Address � "` <br />City, State, Zip � '� ✓ �, " � <br />' % <br />Owner (PAortgagor�_ � � — <br />Billing Name <br />Connection <br />Phone ' - � I � <br />DESCRIPTION: <br />Lot 1� - ''7 Block � <br />Plat — '/ <br />Unplatted Descrip{ion. <br />CHART N0�— � <br />%�o S %��� <br />z_ g-� � <br />�� <br />�1 ility Account No. <br />Permit Fee y�— — <br />/ ' <br />� Connection Chargels) <br />� Total <br />Signed ' <br />Cusromer <br />Sewer DisV <br />Monthly Sewer <br />Monthly Sewer Constr. <br />, <br />. . � <br />o: � yf .�, n �:,� <br />�� ✓ h. . J�� `�>�� A. t" 6: '+�,+ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry En9inecr . <br />Issued BY_ <br />Inspection By �`" �'"""""o—� <br />Date Inspected � �G'��� <br />NO. <br />f�`. .. _ . . ___ "' <br />� <br />