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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application c�nd Permit <br />NO. % i'. 1%� DATE �'"'"��" I+� <br />Service Address -r�s �> �='T -' -f ' �'� �'- ty <br />Bil�ingAddress_�t`� • -�-/ .' %� i� <br />'/ � ' <br />City, State, Zip r"" + ' : � �-`J�� . .: ! � <br />7wner (Mortgagor) �_ �. _ ;1:.;,: :. —=`—� � <br />Billing Na <br />Connection <br />DESCRIf'TION: <br />Lot <br />Plat - <br />Descripti <br />T�mo Parmit <br />� <br />_ _ j ' : � L/ <br />M <br />CHART N0./��� <br />��. <br />`j.",;.`a.;�:?� ' <br />�s����� : <br />� )�-� <br />Utility Account No._ <br />� <br />Permit Fee -3U ��/ _ <br />Connection Charge( <br />Total Fee <br />..r „� <br />,:�' ;. •'f,' <br />Signed. ""' -•" ';� <br />Customer <br />Sewer Distnct <br />i, i i) <br />Monthly Sewer Service <br />SEESKETCH ATTACHED <br />Monthly Sewer Constr. <br />Abutting Lot Line �; �; � <br />N S E W ;'j ' �':.,.. <br />r� <br />Approved By • •� =" <br />Ciry Engineer /� <br />% <br />1 � ?�Issued Bv �' ' �--�-`- <br />Inspection E3y � "� � <br />Date Inspected � � G —. <br />NO. <br />1' S . Y � <br />1 p, <br />''� b� 9 a r'�. 4 e �_ t � y���•�� I�'e r '� '� _`�"8k� � <br />,,ti:� y� az - c �: i. �... _w'�, �x <br />J-�� i.`yr�.l���' 1� <br />