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�, <br />i evered <br />; � <br />I <br />{ City of Everett <br />E��gineering & Community Services <br />Sewer Appl�catian and Permit <br />, ; <br />N0. 21 � �� � DATE ' i �� �� <br />Service Address �� -� � 1''' '� n' A�' � Utility Account <br />Billing Address 'i Uc�/ /'!= "! .�.iv . <br />City. Siate, Zip !�� /+ � �` O � /:�A . %`o � C' <br />Owner (Mortgagor)%�" %`- f'A� ` �% i+'``^ � `�y <br />Billing Name — �� "t =" <br />CHART N0.�5/ 1�— �� <br />� C> S � ✓� <br />S=�-7� <br />Permit Fee � �'"�� <br />Connection Chargels)__ <br />� J <br />r L1 <br />Total Fee " <br />Connection By � U G %^' :�'7 : ;i �� ` ,�� .j c� <br />AddressL� /� ��� � � � �U L �' �'E Signed �r/ " � � � <br />/��7Y /l T �'C=. ;�vi. j, ,�,�' Cus�o r <br />Phone — - "� ;;F <br />DESCRIPTION: <br />Lot / �� Block <br />Platf / �' f•� ? �l - q,i �E N � ti A, J_ ,c;�:. `' i <br />Unplatted Description <br />0 <br />SEE SKETCH ATTACHED <br />Sewer District , <br />Monthly Sewe� Service <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, W <br />! , . <br />ApprovedBy,-- �`�—:.y . �.._ <br />c��v e6o�o�� � -, <br />Issued B.V"��' ", _ - - .,/ <br />Inspection <br />Date I <br />� •\ <br />. - r ' a,s,� <br />