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everett � <br />� <br />City of Everett <br />Engineering & Community Services <br />�.c,�<— <br />Sewer a4pplicaihion and Perrv9it <br />w. <br />��� <br />CHART N0. �' � � <br />��� :� ,: �--.?:'? ( i E <br />NO. `' �i_ . ': !� UATE i_� , % / j;// �. <br />' - <br />Service Address � ' . O = . � :;. : �:-- -; ., .�/ Utility Account No.�_ - � S- _'; : ';. n 1 <br />Billing Address - �C�. /Jn n� :' S�/ � U / pzrmit Fee in J�� <br />Clty, $tBtB, ZIP_. � �.i.,-.�. � %� �:..�� %,X,i ��`��.-� �� Connection Charge(s) '� ' ��}r �`�e';j <br />-"J .. / , ` J . <br />Owner (Mortgagor) ' � . / � . � . (� G . �__ Total Fee ��� C � <br />Billing Name � � /, 5 . �— . <_.. ,--: ,� <br />/ / i; / <br />Connection By_�. : �/, � ..�-�.,�. .T % _r 7 • <br />Address�'� � J /, �?r ' S%5� v• 1� r'TT�- <br />;1... - - ;'"C` - <br />Phone— _J �` - � G' U ' " <br />I� � � <br />Signed �!`;h i�', �, . / ' � , <br />..,.i .' `�I i�f�— <br />�' Customer ' <br />DESCRIPTION: Sewer District_ .:� � ; <. / � <br />�ot Block � <br />Plat Monthly Sewer Service <br />Unplatted Description��: �:•� • /p � = `� -7n • Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />- - - i �' , � _, <br />Trunk_ //, �.:� <br />Lateral <br />Abutting Lot Line <br />N, S, E,'VV_ <br />Approved By ' • � <br />City Engineer . <br />ISSUBCI By - _ / <br />�� <br />Inspectfen_Bu�� <br />• �- <br />)ate Inspected �/ <br />O, <br />