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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />> 5'�;. <br />s :;"�cr. ���. <br />,� <br />r� <br />( � T���t('N�i <br />t� <br />Sewer Application and Permit <br />n �� G�; � C• _.�L_u.�L <br />N0. [� e ti�! t� DATE <br />CHART N0. w'T I g" a—y —> <br />� =.s� -re -�_ <br />a <br />X, r 8 -��- 5 ^ <br />�7d J �G�� � , <br />/� .t <br />�.. <br />: <br />Service Address '/�iQ � ��`� �r+• . , -, < . Utility Account No. <br />./ ' ..r� <br />Billing Address_ �l ��� -� �%-=-��-rrr �. ,:-c�, Permit Fee ��' -'�'� <br />� / _� <br />City, State, ZipF'�%z� `� L� !�/2 • Connection Charge�s) <br />Owner (Mortgagor) /�. ( l' � ./�„<_� ,_ � �J • Total Fee %� �� <br />Billing Name%%/.l( ca .�s•;.� ✓ �:�-,�'.•;;,-/ f!!,r_.c_�•� <br />Connection By �%=.� -: :.-i <br />�':-�J�:J. ' � � �d 0 �.. <br />Address f �-�-' _� �-:/ • q �. Signed_ I�'�^ J� �/��.N.Q..�.... <br />� �' Customer <br />� � <br />Phone � ' � - 'y % % =� i <br />DESCRIPTION: <br />Lot <br />Plat <br />Unolatted Descr <br />Type Permit: <br />_ Block <br />ion <br />i• <br />/,-. , .v -;' � iv i ,' . <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 � �'�-s�-� -, - <br />- Ciry Engineer <br />r i <br />Issued By '^ • - <br />� <br />inspection By� <br />Datelnspected �/ <br />NO. <br />I�r .i: � �F <br />