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r <br />�� <br />everett <br />� <br />City of Everett <br />En�ineering & Community Services <br />Se�rer e4pplict�tion and Perrnit <br />, <br />� �� _ r�_ .� <br />CHAFiT N0. <br />�-'.> ,--- r� cs d <br />� _ - �, `l ,.. _ � �- �- <br />; N0. <' ;j.; ..I. DATE <br />IService Address �� � J �` Utility Account No. - �� <br />f <br />� Billing F,ddress i',� �. :./ .%G l Permit Fee <br />' ,. '�.-- <br />I City, State, Zip_ -� � %> �., - Connection Charge(s) -- �% <br />� : <br />Owner (Mortgagor) � "' � Total Fee � <br />! Billing Name _ - _1 <br />� Connection Bv_ _- <br />Phone � -'%�— +� %�l <br />DESCRIPTION: <br />Lot '"% <br />Plat = •'. - <br />Unplatted Descripti <br />. T..__ !l____:�. ... , <br />Block <br />� <br />Signed <br />Cus�omer <br />Sewer District %' � /; / <br />i �' , Monthly Sewer Servir.e________ __ <br />.` <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line_, <br />N, S, E,CUy ' �O _ft. <br />Approved By- <br />City Enginccr <br />I SSU CCJ <br />r � <br />Inspectian By �'-�� <br />]ate Inspected � � - � <br />NO. �i ��� �; .'. <br />� _ , <br />, t� .. , � . <br />b�r. <br />i , _., �.,, �- _. � ' +;%} i`::t�.. � ; . �.,.� ; <br />