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evereri <br />� <br />City of Everett <br />� Engincering & Community Services <br />Sewer Appli <br />�� <br />� <br />N O. ._ i <br />� <br />� <br />� <br />cation and Perrnat <br />DATE �� ' <br />Service Address �� � � ' "` `� � <br />Billing Address �� �� � '' � l ` �r � <br />� � � � , . j ., �;�, <br />City, State, Zi � ! ' �`' ' <br />P_ ' <br />Owner (Mortgagor) �--�`' `� <br />Billiny Name `-''� <br />Connection By " � � -- <br />Phone _ '- J - t: >"4 U <br />DESCRIPTION: <br />Lot -> Block <br />�, <br />Plat 1' <br />Unplatted Description <br />CHART N0. L�'f � " � �r — <br />�= � - r� .3l <br />6 <br />Utility Account No. � - - <br />�;..;:;/ <br />Permit Fee. <br />Connection <br />Total Fee_ <br />Siqned_ <br />� <br />;i <br />� <br />� <br />. -' 6 <br />, � <br />Sewer District �' � <br />_r ; <br />Monthly Sewer Service " ` "� <br />Monthly Sewer Constr. <br />Abutting Lot Line. ,. ,;� <br />N, S, E,; W_ <br />Approved By- <.'r <br />City Enpineer <br />Issued BV � ' — <br />� <br />Inspection By u�`J <br />Date I nspected �/� <br />NO. ' <br />�� - z -�� -�---�- <br />; ,. _ _ _ <br />