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everett <br />e <br />City of Everett <br />�,;,. . ,. A / -- _—» <br />�C/'`Irr`�;'-R,".� <br />; ���, �.. ,��. <br />����� ,:�����,��;,t��ar <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. �_' _ `_' DATE ` /,.' `' ,/,�7 <br />�,;. <br />Service Address ' "^ / % � `/ic' , ':` ..�,. 1�- <br />Billing Address �� 7 '' / }' ` � ' ' ..` .'`''f'" . <br />City,State,Zip � '��' 1.�, :���i `�:��0// <br />I �� � -. <br />�lwner (Mortgagor) 'y�`- ' �" ��� <br />Billing Name <br />Connection <br />Address <br />. i_._ <br />CHART N0. � 3��� <br />� <br />/`���` T � :� <br />2-�- 7� .: <br />I�e - "; <br />� <br />Utility Account No. -�' • r -.; %� • d li <br />r�-� <br />Permit Fee > d � — <br />��� <br />Connection Charge�s) '���'� <br />� �%,�"' <br />Total Fee ' � <br />- � <br />t_..�: - - <br />,' `C . � ,.� t � = ,, <br />Signed - <br />Cuslomer <br />Phone � '�-�` ���� gY — <br />DESCRIPTION: <br />Lot f� Block� <br />Plat s-r" .�: %' --''�'- ., -tG- <br />Unplatted Description — <br />-� !- <br />�. . <br />Sewer Uistrict >� � •< '� = �' <br />Monthly Sewer Service r-� • SU �i <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />, is <br />Approved Bv W'r ^r'�rt�-�: � � <br />Ciry Engineer � ' <br />�L? ' <br />�� <br />Issued By 'r' ' � ---=�' ' <br />Inspection By �� ���t—�--- <br />Date Inspected_ ��% <br />NG. <br />