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everett <br />e <br />City of Everett <br />Engineerins & Community Services <br />Sewer Applicatio� � and Permit <br />N0. .�� '��_'�-� DATE � '' - ��/ <br />Service Address ��` �� l� c%,�.-� � � <br />Billing Address <br />City, State, Zi <br />Owner (Mortgagor) <br />Billing Narne <br />Connection By ;' -.�:.{_y % � � _ 1�— <br />Acldress_ /� <br />DESCRIPTION: <br />Lot _ <br />Plat <br />Unplatted Descript <br />Block <br />Tvnn Por...i�• _ ' _ .� <br />CHART NO. �� - <br />� ��� <br />� s�. <br />� �z z -�s <br />�_ <br />Utility Account No. <br />Permit Fee -" *- �- :---C.._� <br />Connection Charge(s) <br />Total Fee -� � ' > � �. <br />'�. r <br />Signed_ - ,. _ � ,:_..� <br />Customer <br />SEESKETCH ATTACHED <br />. . .. .. . _ . .. IfiSPCr�Ii)f.� <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Latera I <br />Abutting �ot Line <br />N, S, E, W_ <br />,, . <br />APProved B�' ' . � -C! �.... _ ., _ <br />�� CiryEngmeer i <br />�'.2 /� <br />Issued By. �"` - � �^ : ( <br />Irspection By ' �%%�t �/f i�'� <br />)ate Inspected � O � � <br />� I � <br />• t <br />J } <br />� � 4� -` .V� .yr, %� yi ` l� M � ; <br />: <br />