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i� <br />everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. `Z Ln. �� j � DATE J - - " � <br />; <br />CHART NO. v`� � l ='%- � <br />;� <br />�cs �`Lr� . <br />� — Z — % <br />Service Address � 'J'� '� ' r �"T -''�:� Utility Account fVo. " � • - ' �%� <br />BillingAddress � J- -- � �" � �- PermitFee �' �� <br />City, State, Zip '`- ` � � v � %' � '' ' Connection Charge(s) �' % �� <br />Owner (Mortgagor)- ' ` � '+� '�! Total Fee = ' � <br />Billing Na <br />Connection <br />>-�: _/1,, <br />l <br />� <br />� <br />Signed� � ` - � <br />CustOmer <br />DESCRIPTION: Sewer District_ " ' ( .LL--- <br />Lot � Block <br />Plat J P /�-G ^ - � � Monthly SewerService � � <br />Unplatted Description Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />IP:fi„r� � r������ <br />Trunk � ' - -. ri.'v <br />Lateral �=�' ='f..! Oa <br />Abutting Lot Line <br />N, S, E, W, <br />APProved By_"'� ,�L: -. <br />• City Engmeer � <br />ssued By ' • _ -- . ( <br />nspection By � <br />�ate Inspected_ ,Q- 7- — 7f� <br />N 0. ' "' ' , <br />�_ <br />�� <br />