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e� verett <br />� <br />City cf Everett <br />Engin!sering & Community Sarvices <br />j Sewer Applicat� <br />� <br />� NO. '_` ;_' � C1 � <br />on and Permit <br />DATE - " � �' � y <br />jService Address ' ' � � '� '"`" <br />� �- � , <br />� Billing Address "�' Z� � ' � ' � ``- <br />� i "" <br />� City, State, Zip yl �- �`�' �, <br />� _ % <br />' Owner (Mortgagor�_ / �' <br />Billi�g Name <br />Connection <br />Phone � S-' ' � �% '' U <br />DESCRIPTI� : <br />Lot <br />Plat � ! <br />Unplatted Descr <br />CHART NO. '� � <br />,� , <br />i� A � �i: <br />" , <br />/��'� � <br />,t � <br />�ti <br />Utility Account No. - '� <br />Permit Fee J `� ' l <br />�,-;_,,i <br />�� <br />Connection Chargels) "' �� <br />To?al Fee � `� ',I' <br />Signed t:, , ,%;, ��. �.,�.^,G: <br />Cus�omer <br />Sewer District — � f �'� <br />Block � _ J <br />Monthly Sewer Service_ '' ' ' -. <br />--i i/ <br />Monthly Sewer Constr. <br />Tvnr Permit: . � / <br />. . � <br />° F � > ��, �.= � io :� �`j <br />Trunk �� � � <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />Ciry Engineer <br />ISSUCd <br />� i <br />InspectionBy'- :' ==,.= <br />i/ � . <br />> <br />Date Inspectc�� r� ��1-"'"� <br />N0. <br />t.._ : . r a:� < <br />