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I _ <br />everett <br />�e <br />� <br />� City of Everett <br />� Enyineering & Community Services <br />Sewer Application ana� Permit <br />NO. l yl `' :.' ',.I DATE I_ ., _�, J <br />.. �',-,, �,_,. ";.. • <br />Service Address � �'—' / <br />Billing Address f ��- �� U� _� i� i' <br />CitY, State, Zip � ���� �r � ' � <br />Owner (Mortgagor�' - �!''% — <br />Billing Na <br />Connection <br />Phone � - -'"� �"`� <br />� UESCRIPTION: <br />� Lot � Dlock <br />Plat ��' ' ' � <br />� Unplatted Description <br />CHARTNO.�J �S—Z� ` <br />� U "� � G ,.'J �-'� <br />UtilityAccountNo. '� � - � "� <br />`, <br />' ;�'� — <br />Permit Fee ` <br />�� <br />Connection Charge�s) <br />i <br />Total Fee _ � <br />Signed <br />� <br />Sewer District J!�' � �1 <br />Monthly Sewer Service r% ~ � <br />Monthly Sewer Constr. <br />Latera I <br />Abutting Lot Line._. <br />N, S, E, W_ <br />�� <br />Approved By •, %:` <br />6ry Enpincet - <br />Issued By<"� ' _�_ <br />Inspection By 1.C-�t''�,L,�' <br />Date Inspected � � T7 <br />NO. � ��_, <br />� y��-- <br />� :��� � y. ��-�';'i"��� . q,..� <br />