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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />S�w�r �4,pplication and Permit <br />N0. DATE _ S' r/ <br />` ( ) �. <br />CHART NO.�� <br />�` t <br />Service Address _�-'� �� i��.-�- •./,r /1�"I Utility Account No. �- �� ' 7�d'- �O <br />^ .-;y <br />Billing Address�^JlJ. � %-- � �'O� Permit Fee__ �C� '� <br />�''� `/ G c, <br />City, State; Zip, P`� l�jc �/j � D � C�nection Charge(s)_ 7�� '— <br />Owner (Mortgagor) r _� �/ � � %� <br />,—'>>� ' Total Fee ) 0 <br />Billing Name .� , . _._�,.. <br />Connection <br />Phone. �J � — ��3 � <br />DESCRIPTION: <br />Lot Biock <br />Plat _ ' !�'�f .�• <br />Unplatted Description <br />Signed <br />Custamer <br />SEESKETCH ATTACHED <br />,�:� �������,�,�a�' <br />'.. r . :., � u . . ... l `�'.F�4�'�. . N'' <br />.� <br />.'y � �.�' <br />Sewer District �� '�.� i�_ <br />•—� <br />Monthly Sewer Service � • SU <br />Monthly Sewer Constr. <br />Trunk ��- ^ 0 �U� ° � <br />Lateral �' �O J jp, pp <br />Abutting Lot Line <br />N, S, E, W <br />-�,/ , . <br />Approved By� ' !J�"--zc. -; <br />Gry Enping¢r � <br />_�,, <br />Issued By '� ' ---"�••- <br />. � . -/�� , ,U <br />, ,. .., , �i� ; o <br />. <br />• <br />� g ; <br />_ L�;'.' � .i . o �S ...+:A � i �.:u� <br />