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everett <br />� <br />City of Everett <br />Enrineering & Community Services <br />Sewer Application and Permit <br />N0. '' I i .�_ `J DATE // �Sc-�•���� <br />Service Address ���V � _— � <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By ��'�' ' � � <br />„ ��--- �i <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />CHART N0. �'-3 —�- :� <br />P� S �'��� <br />r2- �-��s <br />Utility �,ccount No <br />Permit Fee �' <br />Cornection Charge <br />Total Fee " <br />/�p'�• <br />�.� <br />. - �/ : ; <br />Signed .:=<'.r:f ,% ",% :_,._,`. � �� <br />Cusromcr <br />; Th, ': d , <br />-`y � , y : '�'. .e ' r-.... •' <br />Sewer District_ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S� E, W— <br />-� i� i <br />Approved By � ^�' -'—'�'�'`�'.:"� <br />City Engineer � <br />i� <br />Issued By ' _ /, —.— <br />InspectionBy � 'r :��Jn zf*"� <br />Date Inspected��7� <br />• <br />. �: <br />� t , � �3 � -�km <br />p <br />