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T 'Cet1 <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />% <br />N0. r L:'.���i DATE ;,�'/ <br />Service Address ' v " ' ` <br />Billin�Address �( l �--' � j �� <br />�` .. . � � <br />City, State, Zip ' �•� %° <br />Owner (Mortgagor) ' �� ✓ - ' � - <br />BillingName -�---"s-- <br />Connection By - �--- <br />Address <br />..,-- . / - �/ � .'" � <br />DESCRIPTION: <br />Lot y� � Block <br />�. <br />Plat l/., — 1- .,t', •„- ••�. <br />Unplatted Description <br />T...... D..�mil. i / . 1. . <br />�. � � _���- <br />CHART NO. ��� <br />_, ._ � <br />f "r, ,� �' . �� � } . <br />\�_ / <br />`,Utility Account No. <br />;�� <br />Permit <br />Connection Chargelsl— <br />Total Fee � `� <br />� <br />� <br />--' \ ' � <br />_. _ , ! <br />Signed_ � ' �' <br />, �:: , i.: � -�%-`_1-- <br />c�:,o.,,e� <br />Sewer District <br />Monthly Sewer Service__ <br />Monthly Sewer Canstr. <br />Abutting Lot Line <br />N, S, E, W, <br />. �; <br />Approved By ''•� ' <br />City Engineer <br />Issued By '' '= <br />Inspection By �L'`'`�"v — <br />Date Inspected � �3d 7� __ _ <br />� <br />I.; i,,i' ,.. . � �,`;� ° �� ;f. <br />