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_ _-� <br />. _ . . ' '�. <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 2 2111 DATE L '% � <br />Service Address �7/D ��� <br />Billing Address�i �—��f ' �� - - <br />City, State, Zip�f(, 2�����,� � <br />Owner (Mortgagor) _� <br />Billing Name �� <br />Connection By_ �� <br />n,;� <br />CHART NO.�`� `f ' ` '%•- y <br />., � <br />�6 <br />}� <br />'" Y <br />Utility Account No. <br />� <br />.'- �% , l_ .eD <br />,� <br />Permit Fee -�'� <br />Connection Charge(s) =/O <br />'� <br />� <br />Total Fee ? �' <br />Address Sign <br />Phone `�i _S.� �,�%� <br />,�.- �f r. <br />Customer <br />DESCRIPTION: Sewcr District � � T <br />Lot �'�` � • /''' '' /� Block <br />, ., � • �7 � Monthly Sewer Service • r �� <br />Plat-r X fr. r � -- <br />• � - <br />Unplatted Description Monthly Sewer Constr. <br />r <br />Trunk l' � � <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved Bp � <br />Cny Engineer <br />ISSUBd BV <br />��5�)CCtIOit By <br />