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_ ' . . ".1�� � <br /> � <br /> ' everetl I CHARI' No. -�^ /� —� R�4t ' <br /> � e .�� � <br /> ' � r � 1 <br /> i ��5/G ✓ , � <br /> � I� <br /> I� City of Everett `"" i <br /> � 1 . M:� <br /> Engineering & Community Servicas � <br /> � <br /> � Sewer Application and Permit � <br /> � <br /> � NO. 21 .�i� 3 � DATE % -• � /�.... <br /> Service Address 79.3� �d�A`�a,�;/���;� : � <br /> Utility Account Na � - - - /_ ;. �� <br /> Billing Address� � % �7 .: •" - --�'"' <br /> L,�' Permit Fee � �• <br /> City, State, Zip_� ; � � ';� �� Connection Charge(s)_ i�� ' � <br /> Owner (Mortgagor) , .� - �' Total Fee � � `'� <br /> Billing Name — - <br /> Connection By � <br /> Address Signed ��'/ _�C2,v2� <br /> PhOf10 � - � •/ � Customer ' <br /> DESCRIPTION: Sewer District_� � <br /> Lot— � Block � '� <br /> Plat _ Monthly Sewer Service �:� <br /> Unplatted Description Monthly Sewer Constr. � <br /> Type Permit: �w �J Trunk ; o <br /> Lateral �-��T <br /> Remarks: <br /> Abutting Lot Line <br /> '�, S, E, W ft. <br /> r <br /> Approved By <br /> Ciry Engincer <br /> Issued By _ �� <br /> Inspection By � ���,� <br /> � o Oate Inspected���,77 <br /> E�ETCH ATTACHE N0. <br /> �- �f,�<.i'i i;l lOi,.l � <br /> "R <br /> —� <br />