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everett <br />� <br />�ity of cverett <br />Engineering & Community Services <br />S�wer A►pp�ie�ation a�d Permit <br />NO. : � DATF ��— : ; _ . � <br />CHART NO.��^ %� (� ��t'FJ � �-� <br />; <br />-' � � <br />/ � <br />�.'�_�./ r � <br />-�_?i_�� ; <br />���j� <br />i •-. <br />c r � � - . ' ` " :G -:vc� <br />,,ervice Address -.� •, • Utility Account No. � � � " - � <br />Billing Address !�%r:� i Permit Fee ���� <br />City, State, Zip <br />Gwner (Mortgagor) <br />Billing Name <br />Connection <br />i � <br />Ptone ` ` J ri <br />� <br />CESCRIPTION: <br />Lot_� g��� <br />l' <br />Plat ��,.--��c �=• ' l rGta.; <br />Unplatted Description _ <br />l , <br />Connection Charge(s) - <br />- �— <br />Total Fee "� <br />..: �'J.i"�� " i / �' � <br />Signed�-i `��:si. /f,-,, i �_ <br />� ustomer <br />SEESKETCH ATTACHED <br />� - a �-- <br />�`,�,;.. ,; ,, - <br />)r . .k y M���}"r . <br />_ _ .i_' _ _ . <br />Sewer District__ �_ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting �ot Line <br />N, S, E, W_ <br />.,.�d <br />APProved By �' ; <br />City Enyineer <br />Issi�ed By <br />/L!� <br />� <br />Inspection E3 � _ <br />�ate I nspected �°��`7(� <br />N0. <br />�� <br />.. _._ 'y'•�{ <br />