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'�� <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Appli�cation and P�rrncl� <br />, , <br />N0. � L �1:J � DATE ��/al %/�� <br />D/'�G�'��V��' Cd►/1�/ <br />� - <br />CHART NO � �r_�� <br />� r� <br />c� �g T�'� <br />��`� � s� <br />�y,,/� <br />Service Address �"[` `''"-""��� Utility Account No. <br />... �� Permit Fee �� "' � `-`'`"'`— <br />Billing Address - <br />City, State, Zip_ <br />fi - , _.r--�-- <br />. : <br />Owner (Mortgagor)_�'--'—.-'�r %G-::r.,,� _� <br />Billing Name <br />Connection By_-•r ��T' _-�-� -�=-----' <br />DESCRIPTION: <br />Lot <br />Plat — <br />Unplatted Descripti <br />Connection Charge( <br />Total Fee__ �1 "''' �'-`� <br />,% _---- _ _-- - <br />[ (: <br />Signed �'% • <br />Cuslomcr <br />SEESKETCH ATTACHED <br />;��-0 1 i` t �: �`e,�`` � •; i � ';''ti' <br />l t <br />�`r� 4 �J � t� �.:�����i �• � i �.. <br />•w..i, �¢:f� r.,f:E a'l.�24"' M14w�.� "y n6�6.w� � , <br />risi�r_c riori <br />Sewer District _ <br />Monthly Sewer Servica <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />�� v-ot_....._ <br />Approved By�G�'%' <br />Crty Engineer �' <br />� - i'' <br />" � � <br />Issued By�' - � --�-s'� `' <br />Inspection B <br />�,L � -�lL'✓Y�/ <br />Date I nspected � �— �� - / � <br />�- <br />N 0. ; _ �: �) `i (. <br />i� . � .y� <br />