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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Se��r A�pgi�e��f�ar� �nd Pe�r�it <br />N�, � 2 2 E�I DATE --> ��: �� <br />/ _`�> . <br />Service Address 7� 0 t�� �`x� ��--�,._�',�-'. Utility Accaunt No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billiny Name _ <br />� v <br />Connection By � i�. •%�' , <br />`��-- <br />Address / <br />Phone <br />DESCRIPTION: <br />Lot g <br />Plat __ <br />Unplatted Descript <br />Permit Fee -�-�._--�.--' <br />Connection Charge� <br />Total Fee__ �� ---, =-�, <br />/P /% , /J <br />Siyned ( r�-ri�i' ;': /� � r ���� <br />Cusro � <br />SEE SKETC!� ATTACHED <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sew�r Cons?r. <br />Tr�nk <br />Lateral <br />Abutting Lot �ine <br />fV, S, E, W_ <br />�� . <br />i�- <br />.-,G-� � <br />Approwed:By_ ,�-��i �__ � <br />- Ciry Engineer <br />� � / /� <br />I <br />�SStic!:� gV_�/ ' `� ��.�7.' �� <br />_—._ --.—�_— <br />�f1i�CCtI0i1 By'_. _ <br />Jate inspected__ <br />r� o. <br />CUSTOD.IER rOpY <br />22264 <br />