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1 <br /> • _- c. . <br /> everett cH,oRr rvo.� 3s- ay-� <br /> f, — <br /> � ���r"'"� : <br /> City of Everett , ( (c,1,� � � : <br /> l�En�ineering & Community Servicei , <br /> Sewer Application and Permit <br /> r <br /> N0. �._� s� ;) i l� DATE i� /�• -� f <br /> Service Address � ' ( . Utility Account No._ % �/ `� � <br /> Billing Address Permit Fee �i✓ �� � <br /> City, State, ZiF_ ; Connection Charge�s) ' � ' f 1 <br /> O;vner (Mortgagor) Total Fee %�� � � <br /> Billing Name_ <br /> Connection By / <br /> /"v <br /> Address , , . <br /> Signedr� (y<< '::: , <!� / �. � , .-i- <�� <br /> Cusromer <br /> Phone / _ j .:; .- — .— <br /> DESCRIPTION: Sewer District " ; /��_. <br /> Lot =— Block <br /> Plat ' Monthly Sewer Service J <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: - --- Trunk_ �./ ;� � <br /> Lateral <br /> Remarks: <br /> Abutting Lot Lire <br /> , N, S, E, W ft. <br /> � <br /> � <br /> i <br /> Approved By_ '�,�� <br /> Gry Engineer <br /> � Issued By � <br /> C <br /> Inspection B � <br /> a Date Inspected_// � � ' ��_ J'. <br /> i <br /> SEE SKETCH ATTACHED NO. ' ` : , ! 1 � <br /> - I;�!'.;�i'i�i; ;.i,,,. . _ . , � . <br /> � <br /> �� <br /> +f <br />