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�`Ja f¢o � t ` <br />� �o -3-� 7 <br />everett <br />I � <br />jCity of Everett <br />� Engineering & Community Services <br />Sewer Ap�slication anci Permit <br />NO. f � Fj �� .i DATE �/���%/ <br />CHARTNO. �`-/�''' ����i. <br />��"" S �`�`� �:. <br />Service Address �O D y ".«--,,.._ —,!--,"r:'� .�_,;j�jtility Account N <br />Billing Address <br />City, Sta¢e, 2ip_ <br />Owner (Mortg�gor) • r-�:- � '`�• _ ` � <br />i Billing �ame -" �W/�' °- •- `---- <br />� - r <br />�` Connection By._;�-= �'�" ��� �' ._ <br />` �'/(% �, � 7 - l � r.. -. �''� <br />� Address - " <br />Phone � `�j ' �/ J' <br />DESCRIPTION: <br />Lot Block <br />Plat _ <br />i• <br />Unplatted Description�_ <br />Permit <br />Connection <br />Total Fee <br />� ;ri <br />,, >.i--� <br />/ \ ^7 i � /�t <br />J � l/; I �- / i <br />Signed ��;1-� . � � , .�' !v �:'1 <br />'� v Customer <br />. . � <br />l � t� 'il - <br />`���. � R: <br />Sewer D <br />Monthly Sewer Service — <br />Monthly Sewer Constr. <br />Abutting Lot I..ine <br />N, S, E, W. <br />// - <br />Approved By '-' !- �'':' . <br />Ciry Engineer <br />. � � / <br />�SSUe�J Bv���'�,... — _ <br />Inspection By_,���-�-�— <br />Date lnspected���`3"' <br />. <br />N0. <br />