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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. �'.i DATE �� :-- /. / �-,:i. <br />Service Address `? ���% 1 _ — r� <br />Billing Address <br />Ci � y, State, <br />Owner (Mortgagor) <br />Billing Na <br />.�— , <br />Connection By_ C ,j,�� ; / <br />naa.,.._ /y. <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description__ <br />Tvpe Permit: , ' <br />� . .� ,�.._- _ <br />CHART NO.``� — � ' • <br />� ���� <br />//�i7�7 � <br />r�' <br />Utility Account No. <br />Permit Fee <br />Connection Charge� <br />Total Fee <br />Signed_ , ✓� � � <br />�Customer � � <br />. . � <br />i�' , ,; S •;��'"��. �„�:� <br />,� <br />/• <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Latei al <br />Abutting Lot Line <br />N, S, E, W <br />Approved By - <br />Ci�y Engmccr <br />Issued By_ _- fi� <br />i <br />Inspection By -_�',; /� i��{; %i� <br />�ate Inspected /i " .2/ – j�� <br />N0. , <br />,} <br />�� Y�� <br />_ � �I.'_ . _ . _ .� ..d�.. <br />1 <br />