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evc-re tt• - <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. <br />DATE "_ <br />Service Address_ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing <br />Connection <br />Phone_ --- <br />CHART NO. - <br />Utility Account No, i' i "' r > �0 <br />Permit <br />v <br />Connection Charge(s) <br />Total Fee <br />i <br />Signed .(A <br />cmfo"r <br />DESCRIPTION: Sewer District 3-:5" / �� <br />Lot Block Monthly Sewer Service S (i <br />Plat <br />Unplatted Description t Monthly Sewer Constr. <br />Type Permit: I Trunk `O <br />Remarks: <br />9 -- <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By_ - <br />Cav Enguxer <br />Issued By <br />Inspection B //J <� <br />Date Inspected_ S� <br />NO. <br />