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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applacation and Qermit <br />N0. � .� C;1" DATE ���� ��7f <br />CHART N0. �� -�—'^-r----'r---v=- <br />j� � i _ i ,— _ . <br />/'i, -- -F,� � <br />Service Address �'� % ol ,-� �'%� ��� _ Utility Account No. <br />Billing Address n � ' % � <br />� � � "` � � " � Permit Fee <br />City, State, Zip��.- �/ /�/ �/� � O� Connection Charge(, <br />� / <br />Owner (Mortgagor�i_y...:,. . �/ � • Total Fee <br />7 • '' � /' <br />Billing Wame�' �;',._.�_�_, ._.. � '„� , <br />i� , � . . , <br />Connection BY.�'e£� �-c��1.- 1��.-�tf l r-�. +. .c -. � <br />Address 1 %U/ =;E �� C�� �j,�, <br />�';' ��T 1 ; , ./al.. . +/ � .;� <br />Phoma <br />�� � l U ,'f �J -� <br />DESCRIPTION: <br />Lot '» - 3 � Block %Y <br />� <br />Plat i. - �'� <br />Unplatted Description <br />�D S <br />o� <br />0 <br />Signed ; ' �' — " � . <br />Cu<.bm�r — <br />r � � <br />J�; ,� <br />Sewer District �� ��-- / <br />Monthly Sewer Service i ��r--�. /� <br />Monthly Sewer Constr. <br />Tru n <br />Abutting Lot Line <br />N, S, E, W, <br />��-'" _ i / • <br />Approved By - �-.- <br />Qty Engineer <br />), '1 <br />SSUCCJ Iiy '�'-�'� . =. . � ' ,�.: <br />i � <br />ns�ection B � � '^ " <br />4 Y- �L-_.� '--� <br />iate Inspected_ � -Z .3 7 % <br />T__ <br />NO. <br />�:o. <br />