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everen <br />e <br />City of Everett <br />Sewer Application and Perruiit <br />� rvo. 23133 <br />Service Address_ <br />Billing Address— <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connec[ion By_ <br />Address <br />�hone <br />I"iESCRIPTION: <br />Lot <br />Pla[ <br />Unplatted Descripl <br />TvnP Pefrtllt: <br />DATE <br />CHART NO <br />�_�o_�.�_5 <br />P�� <br />12�f �Z <o -5- 7 � <br />__ Utility Account No. <br />Permit Fee_ <br />Connection Charge(s) <br />_ _ Total Fee __ <br />Signed � <br />Sewer District <br />Block �lonthly Sewer Service. <br />Monthly Sewer Constr. <br />— Trunk <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />� I <br />Approved By i <br />City Engmecr <br />Issued By � � ��� <br />� <br />� <br />i i �l��%ji' . i � � [_7— �' <br />Inspection By_� ii <br />Date Inspected � ' �� " �r I, <br />;,:ti��.�.�- rvo. 23133 i <br />\ t_, �� <br />