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We <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />. . - <br />N0. �_ 1 �� .I. ' DATE --�--- <br />Service Address /o/ `/ '""`' • ` <br />Billing Address_ <br />City, State, Lip 7 <br />r � i <br />Awgpr;(Mortgagor) e,-C_ �,���%✓ <br />CHART N0 <br />�t�etJH�K _ r <br />, <br />Utility Account N <br />Permit Fee <br />Connection Charge( <br />Total Fee <br />Billing Name <br />t• r� <br />Connection By <br />4 <br />Address Signed Customer , <br />DESCRIPTION: Sewer District <br />Lot, �`. 16' Block 3G Monthly Sewer Service. <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: , <br />oe..,�rv�• <br />s <br />I� <br />SEE SKETCH ATTACHED <br />f <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />i <br />Approved BY. <br />City Engineer <br />Issued Bye—r ' r <br />Inspection By�o—�— <br />Date Inspected �Y % ' 7 % — <br />NO. <br />INSPECTION <br />ma <br />