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everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit_ <br />No. 2 2 3 6 8 DATE �//� � <br />.S <br />CHART N�_3 �—Z�I— � <br />��� : <br />/� ¢/,��s� , <br />� �� <br />� ,. <br />Service Address �f��� � � ' '' -�/ ' �%�- •--� Utility Account No. <br />Billing <br />City, State, Zip <br />. i <br />Owner (Mortgagor) �'�'' �_.. .' � <br />Billing Name <br />��� -,�-� � r;�„ <br />Connection By__1�t-!., c r . %�%— <br />) <br />c• <br />DESC�PTION: <br />Lot �!-,v 3.� BlockT � <br />Plat _ �; , _/ : '7,• : Cc� �. _/ <br />Unplatted Description <br />T....., o..._:.. /i � <br />Permit <br />(;onnection Charge <br />Total F <br />_.----�'_ <br />Signed `- � � � -•. � <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />w <br />�utting Lot Line <br />N, S, E, W __ it. <br />r.�� <br />iproved By <br />Gry Enginccr � <br />/ <br />ued By ' ' _ / <br />. � <br />.� � <br />�pection By ' C •.- J" ��.�iL�.ii--='-� <br />telnspected " � � <br />• • � • <br />P'Y!'yF � � F � 4. _ <br />! � •{ �T:l .i.h+.�.x.. . <br />