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everett <br />e <br />City of Everett <br />Engineering & Community Service; <br />Sewer APplicatior� and Per �it <br />� <br />N0. �?�� �j t� DATE J � <br />Service Address � ' <br />/� � � �'� ��ti Utility Account No. <br />Billing Address_ <br />City, State, <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection <br />DESCRIPTION: <br />Lot <br />Plat _ <br />Unpla[ted Descri <br />T,...,, r�____ ' <br />Block�_� <br />—� <br />CHART NO.� ."��c' _,� � , <br />%•--S <br />;, <br />�s��� <br />�.�-�f <br />� <br />4 <br />Permit Fee --'� . <br />.---- <br />Connection Charge�s)_ <br />Total Fee - -. <br />Signed �' � � <br />Customer <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTqCHED <br />;� - � - - - • INSPECTIOP.� <br />Lateral <br />�utting Lot Line <br />N, S, E, W. <br />aroved gy� <br />Ciry Enpineer <br />ed By`�.. . ,/ . . <br />ection By � � .�-,o-,t.e D <br />Inspected�_f - ,'�o - 78" <br />• <br />.� <br />