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evereft <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO. � � <br />�osi�U <br />1-9-)g <br />/��! <br />NO. L�U'Iy DATE �� /�,' �7 � <br />: ^:. _ <br />Service Address 1''� �� � 97N �%= c. Utility Account No. <br />BillingAddress ° � =- � '����'<<��` < < �`, Permit Fee <br />Ciiy, State, Zip_ ' <- � �� Connection Charge� <br />Owner (Mortgagor) ` ` ` � "i �. , �� ' Total Fee <br />Billing Name � <br />Connection By '' ' �- <br />Address � � ��� �� �/� t ' Signed <br />D1......, . . . . . � . <br />DESCRIPTION: <br />Lot � `� Block `� <br />Plat '- = �-- <br />Unplatted Description <br />� xa.r . ��.�.-- <br />Sewer District `_f ��' <br />Monthly Sewer Service. <br />Monthly Se�ver Constr. <br />Trunk <br />Lateral__ <br />Abutting Lot Line <br />N, S, E, W___ <br />Approved <br />i <br />r <br />�SSLI('Ci fi): _ <br />. i: ; <br />� , ... , i ;, ;' . . <br />i: <br />Gty Engmecr <br />_f t. <br />Inspection By =�� i`--� = LL _'v�o��_.. - -- — <br />Date Inspected � � 7 <br />N0. <br />