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everett <br />e <br />` City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. / DATE <br />Service Address <br />7 l <br />Billing Address/ r (' <br />City, , StateZi f 7(' <br />P--- <br />Owner (Mortgagor) <br />Billing Name 0"'Ll " = <br />Connection By <br />Address <br />CHART N0. `— -.9-s- <br />PO 7-d- 0 <br />Utility Account No <br />Permit Fee_ <br />Connection Charge(s) �' J `� r/L ''-7 7 <br />Total Fee — <br />Signed/Fi / .e •�.,---r---- <br />Cnslomm <br />DESCRIPTION: Sewer District ((" <br />Lot ( Block ri Monthly Sewer Service <br />Plat /I <br />Unplatted Description Monthly Sewer Constr. <br />Trunk <br />Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />4 %') <br />Approved By ! / <c t.:n.)� <br />City F.npinem <br />Issued By <br />Inspection By <br />Data Inspected_PAP <br />NO. <br />IN%)(C11h1r <br />