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/ <br />everett ,� <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application ar�d Permit <br />N0. _�.� !i c�� `; DATE i � <br />Service Address ' � � - - <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By ' <br />� <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description_ <br />T....o Dormir• <br />Utility Account No. <br />Permit Fee <br />Connection Chargels) `—J <br />Total Fee <br />_� <br />Signed <br />/Cusmmer <br />. � <br />� ,_. ,; , . , , ;i <br />�,irt l� ��.i�' 'df '�k <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />1 <br />, <br />., �: <br />� <br />Approved By �'� � � <br />Ciry Enginccr <br />Issued By l � <br />Inspection By �JJ�'�x�����"� <br />i, ; /. <br />Date Inspected ''d %/% <br />NO. <br />. <br />