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i � -- <br />� everett <br />�e <br />� City of Everett <br />Engineering & Community Services <br />Sewe� Application and Permit <br />�- <br />CHART NO.��- =�'� s <br />��oS�c=� � <br />n,o. 21 J 2'3 �'�„! DATF �l �" i %% L— <br />Service Addr �"� � -- Utility Account No. <br />Billing Address -f f G;� / �� "' /"r ' -C� -�. �� . Permit Fee_� <br />City State Zip'17-''"',,_, °'� r'`' �v '%Y03�Connection Chargel <br />. � n.% <br />Ow�er (Mortgagor)_��' r�'' '� f-�' Total Fee 3 v <br />Billing Name ��' �� ���'� <br />Connection By %"`'ITG""'�'- �`� � r, ,/ <br />Signed ;'�Cc,-t J` ...!_f- _/� <br />Castomer <br />DESCRIPTION: <br />Plat � <br />Unplatted <br />�76-- �D/ � <br />_ Block � � <br />c .. ':�/G.c_ � : (.a.i <br />Sewer Distnct <br />......- ; <br />Monthly Sewer Service � <br />Monthly Sewer Constr. <br />Tru <br />La[eral <br />Abutting Lot Line <br />N� S� E, Vy !/ '�:. � ft. <br />. <br />Approved By^~, • , - <br />Ciry Engineer � <br />... <br />Issued By "'—''--'``` / <br />Inspection Dy ����%�^' <br />Date Inspected�7 <br />� <br />