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CHART N0. <br /> � everett <br /> � <br /> City of Everett <br /> Se�nr�r Applieation and Perrr�it <br /> �vo. 25377 . o TE Z !.?�-- — <br /> �DCIU SL�Gl — /��C�CG�� <br /> Service Address - - Utility F�ccount No. <br /> Billing Address � Permit Fee � <br /> City, State, Zip ` � ' Connection Charge�s) <br /> Owner �Mortgagor) ' %� !1- �' '- Total Fee � <br /> Billing Name ' /: /C .- : , . c_ — <br /> Connection By , <br /> � ,r� % <br /> Si ned � � <br /> Address 9 <br /> Cuslumer <br /> Phone <br /> DESCRIPTION: Sewer District __ <br /> Lot Block <br /> Plat Monthly Sewer Service_ <br /> Unplatted Description "' ' Monthiy Sewer Cunstr. <br /> , ; Trunk <br /> Type Permit: . <br /> . Lateral <br /> Remarks: �c�-�.,,',�0�_ Grv;,,n. Qt,�.�,� c� <br /> —i�= <br />