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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�lication and Perrnit <br />CHARTNO. T /3—G'''"'�� <br />-. �-' �!� <br />N0. (1�n_ DATE `�' >��� I - <br />Service Addressl � " � ��� '•��`1 Utiliry Account No. � � � � �v7'� � o J _ <br />Billing Address. �' ��%�'t•% — Permit Fee 3�� <br />I City, State, Zip %= �/r n i' >� l�t/��'� N % F� ?� Y Connection Chargels) <br />� <br />! Owner (Mortgagor) �LY�tIlV ' F� �;�' Total Fee�� — <br />j BillingName `-���%���' <br />iConnection By ��-� ��Ce� <br />�Address Signeu /� • % � � <<�'� - � � <br />, . / Cc:tomcr <br />DESCRIPTIUN: <br />Lot � Block <br />Plat i��a! �; � n �' �L.0 i/\ <br />Unplatted Description <br />SEE SKETCH ATTACHED �_ <br />., .,. .� . '�.i�'�. <br />� �'� <br />Sewer District j� J-=-' ?• A � 1 <br />Monthly Sewer Service 2. S�J <br />Monthly Sewer Constr. <br />� <br />y �a <br />Lateral 2 . "7 j <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By � fJ��'/�-i�-r-� , <br />City Engineer <br />� ,�� <br />Issued By �- fd�-�-"-�J <br />� � <br />Inspection By��'L�'^^� <br />Date I nspected C���f -- <br />N0. <br />0 <br />