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� everett <br />,e <br />City of Everett <br />Enginecr��g � Community Servir,es <br />Sewer A�aplication and Permit <br />NO. , ' DATE 'L, /'. <br />' Service f �dress � . � ' .- / <br />Billing Address' ' r.' , r', ! � -- <br />� CitY, State, Zip ' ' ; / / • �i i�., / i / <br />i �_ <br />i <br />I Uwner (Mortgagor) � i�n• , :� � • ,; „ <br />I Billin�� Name i <br />� - <br />Connection By � �, <br />t <br />i <br />; Address <br />� - <br />� Phone �_� �- � � y/ <br />� — ------- <br />! DESCRIPTION: <br />, Lot _ Block <br />� Plat � ' / i, , ; �i ; . <br />Unplatted Description <br />I <br />I Type PermiC . l�( c. (,: <br />. �ri: rc'/i! .._ <br />Remarks: <br />CHART NO.���_z$i�S� <br />Utility Account No. <br />Permit Fee <br />Connection �harge�� <br />Total Fce___ ___ _ <br />:iiyned.------- <br />c„-stornr� <br />Sewer DisVict � �.'� / > J. / i�. <br />Monthly Sewer Service ' � � <br />MonUdy Sewer Constr, <br />Trunk ' <br />Lateral <br />1 A6utliny Lot Linr, <br />fi, S, 1', lV <br />i\pproved BY--- . <br />��� i„��..�„ <br />Is;u���l liy_ _ . <br />/ <br />i i <br />� r <br />� / �,_, _ <br />� InspecU�mBy_�_J-C_(�>icr>. � <br />---- -----�— ------- <br />a ------ - -� . _. .. <br />____ Datelnsp�rted�'3c� � <br />SEESKETCH ATTACHED J <br />� <br />N0. <br />n_ �:.�� <br />� l :� f.�:-i .41,v: <br />�: ° ..., h a. .. � w� _ .. ., . . _. s. <br />. .. . . .. . ... . .. . . r. SE- . , . . . . <br />1t. <br />