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a <br />� <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicatiorr ar�d Permit <br />N o. `� "� '� 3 `�; <br />DATE '' ' <br />'� ,<�'— <br />CHART N0. � ��� "�� �� � <br />�o., ��,Q 3r <br />y <br />Service Address ' � - � Utility Account No. '� " �/�- ` v / <br />�r-�' <br />Billing Address <br />,_� ,�. T�,! _-� ir- y Permit Fee �'� <br />�,;�- <br />City, State, Zip r✓/- ii i� 7� � v•�( /:' -" �" Connection Charge(sl �� <br />_,%i <br />Owner (Mortgagor) � - � �� ��/N i/r, �' %� /�Ut= Total Fee �� __ <br />Billing Name - � "�� �= <br />Connertion By --' A �> >� <br />Address Signed <br />cuswraer <br />': i .f— /;� _ U(1 <br />DESCRIPTION: <br />Lot / Block <br />.> <br />Plat � ,��, � '� <br />Unplatted D�scription <br />Sewer District J �' ��� �` <br />��� <br />Monthly Sewer Service -- ' <br />Monthiy Sewer Constr. <br />Lateral <br />Abutting Lot Linp.� <br />N, S, Et..iti' i`�`' ft. <br />Approved By <br />c��v e <br />Issued By � " <br />,�� ����-�-____� <br />Inspection By�,�,.� <br />Date Inspected�7� <br />( ' <br />N0. <br />aE, " <br />. h <br />k <br />, M^i:z+J �'�u �.ca,� . �� i,_,: ,, � .� � _ .. <br />