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everett �, <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. � r� �;�� f i DATE �%' %�` / i� <br />/ : <br />ServiceAddress_! `i�> r , (` i� <br />BillingAddress—/' �� / . � . <br />..:,. <br />CitY, State, ZIp� � � .i�C . �'" _ ;.: ,.i <br />Owner (Mortgagor) �,,-,,,,,�, <br />Billing Name <br />Connection <br />Address <br />:� <br />CHART N0. �Z ��i: <br />/�'��.r�9 <br />,Z_,�$_�7 <br />�r^�•• <br />Utility Account No. -"'"""�- <br />Permit Fee— � � - <br />Connection Charge(s�___..�---"' <br />Total �ee__-- �..._., s,_.`_ <br />Signed_ '" c / i.,. � <br />Cusmmcr <br />DESCRIPTION: SewerDistrict �% i� %` <br />Lot � Block <br />Plat _ ' � �� ,l1 . ' •: t� Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />� ype Permit: <br />SEESKETCH ATTACHED <br />INSPECTIOP; <br />Tru <br />Lateral <br />ng Lot Line <br />N, S, E, W, <br />ied By- • .�C"..,., : . <br />Ciry Enpineer <br />i_ �' <br />�Y n'�r'-l•'�'---�_� <br />ion By � -rv-,+�[� � <br />. <br />spected_ � % - / >' - 7 �7 <br />NO. �n�,:: `; <br />� <br />