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everett �; � <br />� <br />City of Everett <br />Engineeriny & Community Services <br />S�w�r Appliccation a�d Permit <br />N 0. � ' „ '-� ,. <br />J_ `v.;'J <br />Service <br />DATE �%'.> •�� 7 <br />Billing Address � � � • _- '� �� - -' <br />�, , <br />CitY, State, Zip; i/� ,,,,,. . `� ^..::' r.: ;.� <br />Owner (Mortgagor) � r � / <br />Billing Name - �...- <br />Connection Bv - ' - ' -- <br />_ .: _, l // , 5^ <br />Permit <br />CHART N0.1� �J� ' � �' " �� <br />4ccount No. <br />��yP'� ✓ <br />r <br />"; r_; <br />Connection Charge(s) <br />i�' <br />Total Fee �r <br />Si <br />/ <br />/� <br />. <br />1 <br />t <br />DESCRIPTION: Sewer District � / .: <br />Lot �� • Bloqk / <br />Plat ! ', � Z"",., ,; Monthly Sewer Service <br />Unplatted Description � Monthly Sewer Constr. <br />Trunk �> . �� U <br />Lateral - ! J <br />Abutting Lot,�,jne <br />N, s,l,E;�W �fJ ft. <br />Approved By'� �, ��T%f- -��_,c o. <br />Ciry Engineer � <br />7 i' <br />Issued By ,""� _. ._�,�_: . <br />Insper.tion By �"r%'�--� <br />Date lnspected�� % <br />NO. _ �` � ��' <br />