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everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />�. � < <__, � -� -I <br />N0. :�' � � r '� DATE _--- <br />Service Address� "�-'�" ��' �'�`'- `�� `� � - <br />Billing Address'`'�-'"" =, �� �y� ��� ��� <br />City. Statc, Zip �", , 1 v_ �`. i.� u _� c, •_=. 7�;- <br />Owner (Mortgagor) <br />...) ;�. c� t� i` � 1 C, �l> .� � <br />Billing Name ��'""` �'" <br />^� r� <br />�J �tJ�)o:i 'c_- .�.i •�C.�L <br />Connection By <br />i :I Za C.i � !� -" � l.f I� �,,,1 �t_.�, . �; <br />Address <br />-_,_ `._..�, _ -r'f � c� <br />Phone <br />DESCRIPTION: —,��`�,� <br />Lot <-- -" `-'� Block�--- <br />Plat i.=.' J �--�= �z�- <br />U nplatted <br />- ^ _... �-' i � ��� ,� . .. <br />CHART NO ��� 'Z� r `S <br />Pms ��� -. <br />,_,, -� � � <br />,� <br />Utility Account No._— <br />,, . ,�, <br />PermitFee �'� f <br />Connection Chargels) <br />,� • _;Lj <br />Total Fee ''� <br />r ,i�' <br />; �',�..-- i: -�<.�..._.-,_, <br />$19�ed � Customer � <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Tru�k <br />Lateral_ <br />qbutting Lot Line <br />N, S, E, W_ <br />(_ E-i�::>F.l � ,�c� <br />qpproved BY <br />Ci1y Engineer <br />Issued By � ��`���� <br />Inspection dy `�! �'�v—�'r`���''-� <br />Date I nspected l� ���� <br />NO. � <br />