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e� erett <br />� <br />City of Everett <br />Engineering & Cotnmunity Services <br />Sewer Applicat�on and Perrr�it <br />N0. �< .�'' �. I��' .i. DATE ? j, i_. <br />Sen-ice Address j , /�:' ! . <br />BillingAddress- %�` • l'_;s �__ i / "/ _ <br />CitY. State, Zip , _ ��/ j.t . /`�'.� �� ;, <br />Owner (Mortgagor) � ��l- <br />Billing Name <_.- <br />Connection By ,_ _. <br />Phone %=� .i • % � �� <br />DESCRIPTION: <br />lot � Block_ <br />Plat �- —� � ii'.., . .'! J <br />Unplatted Description <br />Type Permit: ,� . <br />Remarks: <br />SEESKETCH ATTACHED <br />tr+'-c�4a�q1 g�es..� :i'[�:Cl-li?i��� <br />. . ""'rA -s. �r��— .— .rvc _ _. <br />CHART N0. � l��'^� <br />�� .� Te.r E� <br />�—�' � � <br />!2�''�i� <br />Utility Account No. .� '> - % . G <br />Permit Fee � �� �I� <br />�"- <br />Connection Chargels)_ rJ K �' <br />_:-- <br />i. <br />Total Fee_ _ � <br />Signed <br />Customer <br />Sewer Uistrict____ % _ - � %LL-- <br />Monthly Sewer Servir,e__.=__- % <br />Monthly Sewer Constr. <br />Trunk_ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W__ <br />„ <br />Approved By _� '' <br />acy e�y��,��- <br />issued Bv -- <br />� <br />Inspection By��-��?c_�__ _ <br />Date Inspected �����7� <br />r� <br />N0. <br />�'. . .--^,.c.^�--P:,.: .��--�<,; .__,_..... _ . <br />�� <br />