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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and I�ermit <br />rva �;_ �i1 � DAT� /ri �_ i �7 <br />CHART N - <br />,�a 3 T-.�-� <br />�� - " 1• <br />Service Address. �^�� -- -.� Utility Account No. <br />;�.� <br />Billir�g Address �—��. �-. '� Permit Fee_ '� a <br />City, State, Zip -� -% t� %� '<v i<�%" Connection Charge(s) <br />.� <br />Owner (Mortgagor) : ��_ _ -� � Total Fee i � <br />Billing Name <br />Connection h <br />� <br />Phone ..J 5" S — ��_� >' <br />DESCRIPTION: - � <br />Lot -> Block <br />Plat � <br />Unplatted Description�% <br />Type Permit: "; ," _ , <br />Remarks: <br />Signed <br />Sf <br />Monthly Sewer Service .� '� <br />Monthly ;'ev�er Constr. <br />Lateral <br />Abut;ing Lot Line <br />N, S, E, W. <br />Approved By � <br />Ciry Engineer _� <br />ISSU@d BY - _ - � �_ <br />Inspection By .�.V -"-L ! <br />Date In;pected��G�7d <br />� . <br />0 <br />�.i � °'� ::� i L''' � t�{ �r r'•_ � 2'� i b <br />� v�;� � <br />