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evcrett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />ND. Z 1 d/ 1 DATE <br />Service Address % / - '/ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) — <br />CHART NO. Lice <br />Utility Account No. <br />n� <br />�1 <br />Permit Fee iU <br />Connection Charge(s) S <br />_Total Fee <br />Billing Name <br />i <br />Connection By - Y L—� -- �,,,, N. ..•.� <br />Address Signed <br />_ � Cato <br />Ph( ne <br />DESCRIPTION: Sewer District- <br />Lot— Block <br />Monthly Sewer Service <br />Plat <br />Unplatted Description • Ik �;, Monthly Sewer Constr. <br />J� <br />Trunk <br />Tvne Permit: <br />SFF CKFTCN ATTACHFII <br />Abutting Lot Line <br />N, S, E, W <br />Approved 8y <br />i <br />City Engineer <br />i <br />Issued By <br />Inspection By �/— �w-.9 <br />Date Inspected <br />NO. <br />