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lI �O P�n o'.. � o �� ._ - C- :�. <br />�\ <br />everett <br />e <br />City of Everett <br />Engineering & Cammunity Services <br />��w�r A��sl�cGtior ac�d P��rr:i� <br />� ' t� �' � DATE / �'� - !� <br />NO. �. ' ., .� <br />Service Address �� � � � - ( <br />Billing Address "��' • � <br />�; , i <br />. . , - Y /�:.4. <br />� b�• <br />City, State, Zip � �' , ��� `' '� �� <br />Owner (Mortgagor) � / <br />Billing Name �--� <br />Connection <br />../._ j'' ��.j J ` <br />Phone <br />CHART N � "� �`—p-- <br />/`�v S � �� <br />G -, -�_ - � �' <br />Utility Ac�.,unt Nc. <br />� <br />Permit Fee_.L�� <br />Connection Chargels) <br />_3 J , :�%- <br />Total Fee <br />Signed <br />DESCRIPTION: S' <br />Lot .� Block <br />Plat � <br />Unplatted Descriptior� Monthly Sewer Constr. <br />Monthly Sewer Service � ' ' U <br />SEE SKETCH ATTACHED <br />I + . . I'i:.CTli�r., <br />� �4i+va� .._ , a.. � . <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By -- '� <br />City Enginecr <br />,, <br />% . <br />Issued BV - <br />Inspection By_�}�'7 ��''—� <br />Date I�spected � � S '-Y <br />• <br />� " � , �' <br />,.: � .- ... hJ c <br />L'� <br />