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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�lication and Permit <br />��- � y <br />CHART N0. 7 - - r` �R "` � <br />-� _... . � ..:� - <br />� , <br />�' � —�� �� <br />f. ; _ . <br />f; ,. :. <br />NO. �� li i; :.; � DATE , ,� _ ' ,'',, % I— <br />Service Address �`�^2�O %�`���o`"' ��-� Utility Account No. <br />_! i_ <.- ,c- <br />` BillingAddress � '�' � f ' �'''- r � ' • ' Permit Fee ��� l <br />I � <br />City, State, Zip f G < h �" 7 � � . :1 ' /h --' �� '� Connection Charge(s) " � �' <br />i ' <br />� Owner (Mortgagor) -'-�'-' '-= -'� --�- � f��/r- Total Fee <br />� �9/j%NU ���.f�/L%�'L/ <br />� Billing Name � • <br />Connection B <br />Phone � ��� ' %�' f � � <br />DESCRIPTION: <br />Lot -� �% BJock <br />Plat . /��c;_ ;..i. - %r .� D //�. ,Y <br />Unplatted Description <br />�:..'�''�----^- —�-� : <br />Signed ` l ,�"::1,r-- ' ,'.'� <br />Customer <br />Sewer District � <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N,S,E,W_ <br />:� <br />Approved By � ` — <br />Ciry Engincer <br />I <br />Issued <br />Inspection By Jrc��- lsvo� S �-�� <br />Date Inspected G' Z� > > <br />NO. <br />