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Y <br />er2reft <br />� <br />City of Everett <br />Engineering & Community Services <br />S�wer Application ai�d Permit <br />NO. ._ _C ti i ! DATE : :� -� �`/%' % <br />ServiceAddress %' ` - � " r�%%- -- ' <br />Billing Addre=_s '� '� ^ -j %%�� /'�.• . �%` � — <br />City, State, Zip �'G'%' ✓�T 7% ,(;i,i ''/> � r.ti� <br />Owner (Mortgagor) � �� '�^ � � � ' '' '� ��' ' <br />Billing Name '� '��� �- <br />tl .i�� <br />Connection Bv <br />Address <br />_ � � i,- <br />Phone % ' , . •- <br />DESCRIPTION: <br />Lot � Block_ _ <br />Plat —_ <br />Unplatted Description <br />� <br />CHART NO.�=""�`� V � <br />�� `,-u � �. <br />Utility Account No. -- � ' ' i-�' " `�� <br />Permit Fee. <br />l � l' <br />F�--- <br />Connection Charge�s) - �� <br />Total Fee - � <br />Signed . ' ..:._ ,.. : . . ,.- <br />Cu,tomer <br />� r }�� <br />$ t / <br />Q`��.\.>�:e�' � <br />Sewer District � �/ �� <br />Monthly Sewer Service ` �-' <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By -� �"� <br />City Enyineer � <br />Issued Bv_' <br />Inspection By���-- �. <br />Date Inspected ���% — <br />N0. . <br />�a� � � sgt� e <br />�5�4 rm-, <br />y�,}'i <br />� tq:� ik!S :'� e� �:. a. `�S-�_' <br />