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`/ �/ 7C'_C/ <br /> C�1.4RT ��in J�;.57 C_ / / <br /> everett �� -- <br /> � y ` <br /> I '(�a/'..�^�.�.� <br /> t <br /> -� � , ,. . <br /> , -.;� ; <br /> City of Everett �-> <br /> Engineering & Community Services <br /> Sevorer Application ahd Permit � <br /> N0. ' ' �_ '; DATE �------ <br /> Service Address � � � � ' Utility Account No. � <br /> �i ��i ..� - � �i� " . . � �— <br /> Billing Address � �_� Permit Fee <br /> City, State, Zip / ' .i Connection Charge(s) <br /> Owner (Mortgagor) � Total Fee_,_ <br /> i <br /> Billing Name _--1� <br /> Connection By __ <br /> Address Signed' -. <br /> � ' Customer <br /> Phone_ j <br /> DESCRIPTION: Sewer District � <br /> Lot f Block _ <br /> – Monthly Sewer Service_ <br /> Plat : –. —— — <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: – "" _, Trunk i � - <br /> Lateral <br /> Remarks: <br /> — Abutting Lot �ine <br /> N, S, E, W ft. <br /> Approved By • <br /> Ciry Englncer <br /> Issued B��"' _ ( <br /> . .�� � / �� <br /> _ Inspection By �" ���_•�� �L�u� <br /> e Date l nspected � '_���� <br /> SEE SKETCH ATTACHED �O. <br /> :�. <br /> �.. <br />