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I <br />� everett <br />I � <br />ICity of Everett <br />� Engineering & Community Services <br />Sewer Application and Permit <br />-'J - `� � <br />NO. C, �. ;i & C r DATE _ / <br />,_�� ^/�«, '� � <br />Service Address �� � � ' � <br />Billir.g Address %��� ^ � %�' ~ <br />City, State, Zip - <br />�� .•iL � /i' ii <br />; <br />CHART N0. — � � <br />/ � 'S �f� <br />Utility Account Na - � <br />_, <br />Permit Fee � r� � <br />Connection Charge� <br />Owner (Mortgagor) l Total Fee <br />/ <br />Billing Name �--� - <br />Connection B�� <br />Phone <br />CESCRIPTION: <br />Lot � <br />Plat <br />Unplatted Descrip <br />i / �'. .. �� ✓ <br />i : ' — <br />r� <br />,:: > <br />' J .:.� <br />Signed - . r: . - — ; <br />custamer � '• �i <br />j <br />Sewer District � � � � <br />../ <br />Block Monthly Sewer Service_ '� '� �� <br />r.._., o,....-:.. . _ <br />. � <br />. -p. '641p:.: " b; �. 3� � z t: �4`: '`.��'_..^'r <br />'� n� 'n`,�1 tdifr �:: I <br />Monthly Sewer Constr. <br />Trunk .:.-�8" �� �-3~ <br />l.ateral 3�'� ' ^ s <br />Abutting Lot Line <br />N,S,E,W <br />Approved By ` . , % <br />City Enginccr <br />I ssu ed <br />ft. <br />�, � ► r <br />�. � . � <br />• <br />;,. . p..../ E�'.: 11 . �.�.., <br />� ' j. <br />¢ �'S' � -� > a .,'�,�.r`�_ '�r�:, i �� r"'Y�', <br />