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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />''� Sewer Appliccation and Permit <br />� <br />NO. DATE / , � <br />Service P.ddress � � "' � `' �� ` � <br />�%�1 - i .: %G % <br />Billing Address <br />,: � ��''' /:; :f: <br />City, State, Zip � ' '�� — <br />Owner (Mortgagor) ' � <br />Billing Name <br />Connection <br />DESCRIPTION: <br />Lot � B� <br />Plat <br />Unplatted Description_ <br />CHART N0. r`����`��� �� — <br />�7., _c.. r�= '� � ; l..% <br />- ���— = - :�/ <br />Utility Account No. — <br />, ���i <br />Permit Fee = �" <br />Connection Charge(sl ' `� / � <br />J ;? _ 1 <br />Total Fee <br />Signed <br />'-'i <br />Sewer District '^ �� �—'` <br />Monthly Sewer Service ^ � — <br />Monthly Sewer Constr. <br />=� .—� <br />Trunk ' , <br />Lateral <br />4butting l.ot Lin�, <br />N, S, E[�N-' �C� ft <br />APProved BY "�l' <br />Ci�y Enr�incer <br />Issued <br />Inspection By �� �( �'`"`�'� � <br />Date I nspected j��/r7 <br />NO. .. <br />pf ; , �` �r. - , <br />� <br />�'.�_ .,, ' -- , :z-;.. _ . .� _ <br />