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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�►Iicati4n arad Per!�it <br />N0. 1 _; �l;!'�' OATE � — - i'/ <br />`� -/ �� - 1 <br />Service Address � � `` ' " ` <br />� 7� /'� . J "; %l % <br />j Billing Adoress <br />� � �_. , <br />; City, State, Zip ='� �� ' <br />� <br />i :. - . <br />� Owner (Mortgagor), ' �'`"' �'' <br />� <br />� Billing Name_ <br />� <br />I Connection By_ <br />i Address_ <br />I <br />I <br />Phone <br />�� DESCRIPTION: <br />� Lot � <br />; Plat <br />� Unplatted Descr <br />� �' � !�' � '.)�7 <br />Block <br />Utility Accoun; <br />Permit <br />CHART N0. � �T�:--;—��= <br />/��" - � ` � L�- � <br />J. l � / <br />., D �✓5i <br />Connection Charge�s) � � <br />�: �� <br />Total Fee <br />Signed <br />Customer <br />. <br />Sewer District�_�' � /�� - <br />Monthly Sewer Servi <br />` <br />Monthly Sewer Constr. <br />.4butting Lot Line <br />N S E; W i J <br />Approved BY <br />City Engineer -' <br />Issued Bv -" - <br />Inspection By � ` C , �l`^� <br />Date Inspected�;�� <br />NO. <br />���—� ^Ae.'^.rS,iA K i1 <br />� . '' I � �� . ._ �_A`�.' ,�_ -.. �_i__ .� <br />