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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />SE�nrer Application and Permit <br />NO. % �i ' i L� �j DATE _ �� - 'l % <br />CHART NO. �� � ��r� <br />�o> � �11, � <br />�,���., . <br />Service Address ' '•' '� ' } � �+ �— Utility Accaunt No. � - �� ' � ���� � � ��� <br />, � <br />Billing Address '� �� � ' � 'y"' � Permit Fee �"� <br />n �v <br />City, State, Zip : - � =��*'✓ �` � �% �onnection Charge(s) �/ � <br />, . �� <br />Owner�Mortgagor� t�.�' .� �� -�✓% ' ! TotalFee ,.Jv <br />Billing Name `'=��- '-'�"f <br />� + <br />Connection 3y ` � <br />i <br />Address Si9ned � �'-` <br />Cusmmer <br />Phone '' % =' - I/ � � <br />DFSCRIPTI�N: <br />Lot "' _ Block� <br />Plat "� / /i , �. � <br />Unplatted Description <br />Type Permit: ,.'� ..,� �_�.,.-, [_ <br />Remarks: <br />/ i <br />Sewer District�_ -�-� -/ � <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk ��' �'� � <br />/ (�' <br />Abutting Lot Line <br />N, S, E, W <br />•�t-- // <br />Approved By �`-/"'%::: - , .- < . <br />Ciry Engineer , j <br />V <br />ISSIICCI B� � ' ����•'�-"' %� <br />Inspection By � l"�1�--� — <br />Date lnspected_���7 <br />N0. <br />