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everen <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applic9tion and Permit <br />, <br />,; , , , _, <br />N0. E' � �� �� e� DATE '.r,: ) �/- �.. <br />�, , <br />ServiceAddress ` ?�1 r������ � <br />Billing Address � ` ' � � � �v <br />City, State, 2ip � v'� ,G !�..�' <br />� <br />Owner (Mortgagor)%•:'/�-f %i�.n. �' c ;`, -. �. x.c.= <br />� � �. <br />Billing Name�ft -, , ,_� <br />Connection By ;^'.•- �--.• - '�(� <br />Utility Account <br />Permit Fee <br />CHART N0. L` 3' ? S''-'-` � <br />=�s%�=n � <br />�-�-�; <br />�� <br />-`i <br />� k� _. . � 7 uJ <br />, <br />�r7 <br />Connection Charge(s�_ ' i �J <br />To[al <br />� <br />Address / � Y �� ^ + > •- ii !; „ j { , �-Signed 1 <br />�. ���,:� cuvomer <br />Phone � > ��-/� � <br />DESCRIPTION: ' Sewer District ? � � . iJ- <br />Lot �- Block � <br />Plat � . ;� . � Monthly Sewer Service � `� <br />Unplatted <br />Type Permit: <br />SEE SKETCH ATTACHED <br />IidtiPECTIQ; <br />!�lonthiy Sewer Constr. <br />Trunk ��`, <br />Lateral �-- <br />Abutting Lot Line <br />N, S, E, W, <br />�� / <br />APPioved By �'�`�t� <br />c��v e�a���e� <br />, , J; <br />Issued By_ l. :% i=;(Ye>'� <br />Inspection By �/lv-si.t�/ <br />)atelnspected�/=� - -•- <br />N0. ,' <br />