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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer �Opplication and Permit <br />DATE / % C <br />Service Address -� �-� v � : , . : � : �i � <br />Billiny Address G <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />: ,i ! ._,--- <br />Connection By ;� =-� � - / <br />Address :'� � <br />Pho <br />� _ <br />CHART N0._ " � ' � <br />Utility Account No. <br />Permit Fee <br />Connection Charge� <br />Total Fee <br />_ j <br />i <br />.Sj�� � <br />,�' �' Z Z�, �� <br />,�, � <br />/i,� <br />y <br />,�_ <br />�-� <br />Signed_ �.._../ i �.-i _ _ ( . <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block <br />Plat Monthly Sewer Service. <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: —, , - , ,/ <br />Laterel <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By t� <br />Cny Engineer <br />Issued By '"' • _._: �-. <br />i <br />CQu D �-�.,+.e <br />Inspection By Q — � — 7 � <br />Da[e Inspected <br />SEE SKETCH ATTACHED N0. <br />�.`iF� �IC.�, <br />f'< '�i� <br />