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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Pe�rmit <br />N0. ';' �I_ !� ,�� I ! DATE ._ � � � <br />� ���: <br />Service Address ` ` ' '� >> " �'� '� '�• _ <br />BillingAddress <� ' -�✓--/�'=r-'� ' ���� <br />CitY, State, Zip ,,�J�'��L.� �.� � ? <br />Ow�er (Mortgagor) �� � <br />� <br />� �'..� .'_ - <br />Billing Name �- �-�-+- _ <br />1 <br />Connection By � � _ <br />Phone _— <br />i <br />I �•f�ART NO._�___ <br />Utility Account No. � ' 30 ` ' >- �' ' � _'_ __. <br />Permit Fee � �� ' <br />Connection Chargel,l `� iU � ��( �''��7 _._ <br />.� <br />ToVil Fre_ .. _.Ji'�_..---- - <br />Signcd— <br />DESCflIPT19N; � ,' a t / Sewer District � •-� �+ � �� �` � <br />Lot ! � �' Block Z '� <br />Monthly Sewer Servica <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />a / �I(E ATTACHED � <br />Trunk_ <br />Lateral_ <br />Abu[tiny Lot Line <br />N, S, E, W <br />/S <br />a �' <br />Approved By �, �'1' � — <br />C�ly 6�yineer <br />7 <br />�SSUCd BY �'_. '" . . .. . ...-_"— <br />//� ']�-L�—r--- <br />/Y L <br />Inspection By_s-. ��_—�-c—�`----� _ <br />� <br />Date I nspected S _� � <br />N0. <br />. . , ' .. ,o�. 1�.0 <br />