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� everett <br />'' � <br />( <br />i City of Everett <br />Engineering & Community Services <br />Sewer A.pplica�ion �nd Perrnit <br />N0. ;,' !. :� '` ' DATE �� � - % <br />;.: �� <br />i <br />� Service Address /` � � � '�� f'� � ' ` �� <br />' Billing Address "�"��{ ��'''G� `�''`��` <br />' ; : %G- � <br />i _ L , � <br />�—� . <br />i �, . <br />�, CitY, State, Zip �`7 iiir . 'j <Zi;r' <br />i _ / <br />� Owner (Mortgagor) <br />f <br />i Billing Name - = <br />Connection <br />DESCRIPTION. <br />Lot ' <br />Plat - <br />Unplatted Descripti <br />Block_ <br />J,7 <br />Tvna Parmii� . . .- . ... iJ' <br />A ' �j' <br />CHART N0. �'���" �' ' <br />��„ � : ,: � �3� <br />Utility Account No. ' - �i - c: 1 <br />, � <br />Permit Fee J�` <br />Connection Charge(s) ' r� <br />Total <br /><� <br />; ,_ ; <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service_ <br />I 3 � <br />���S�C �I:ETCH ATTACHED � <br />� ,�i•^ ' �:ipL=_C"i IGI,� <br />i � �� � �--- �'. <br />Monthly Sewer Constr. <br />T� <br />Abutting Lot Line <br />N S E, W, �_) ft. <br />Approved By ' ", ':�- <br />City Engineer .. <br />Issued <br />InspectionBy !—� � ' <br />Date Inspected� �/7� <br />� ; � � <br />N0. _.._ . _ i, <br />