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everett <br />� <br />City c� Everett <br />Engineering & Community Services � <br />�ewe� /�►pplication and Perr�nit <br />s <br />CHART NO. �' � • o � <br />r"''c�; <�� ^�:=- I <br />, ,. <br />G'' - Z `� a �"' � <br />0 <br />� <br />, <br />N0. � 2:: v L DATE '',� ���T �"_.. <br />Service Address✓�'� �`'/�` V 7 Utility Account No. j <br />Billing Address�_ ��G' `r T _ Permit Fee �� ��- � <br />� � I <br />City, State, Zip�— `��-��� T 7�'jj�'• � Connection Charge(s) j <br />i <br />Owner (Mortyagor) Total Fee � ��'`-'�= j <br />Billing Name <br />Connection By �-�� ' `� L �' �vt ='�E�7T <br />Signed �...��-I l_., i`.�L'G'_.�_ L� k�l� <br />c��mm�, <br />y <br />DESCRIPTION: <br />Lot Block_ <br />Plat <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />;PR�TIO��. <br />.. �!i � � . �>/i�.. .�a.��' <br />.. ... L .�.. .. .. . .. <br />Sewer District <br />Manthly Sewer Service, <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />f ` i <br />Approved By �• H E=�1 ��►� 1�iU � <br />City Engineer <br />I <br />IssuedBy � �l�<---�--(�l--tA�..J i <br />Inspection By— <br />Date Inspected � - / �� - 7 73 <br />NQ � <br />� �T 3r <br />, " � - _. . . ... �. . . ,_�4 <br />� <br />I <br />,,I <br />