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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Pern�i� <br />CHART NCX��Zq�� <br />j�asi �>,D <br />� � s�' <br />�_ <br />� - <br />N0. �` <<� -' ( DATE ��/77 I _ <br />�� � �/ <br />Service Address��� ���-"p��✓�G. /-��-�� Utility Account No. — <br />.) �; r" ; ; <br />„ ,� <br />Billing Address ✓ c.� ✓�,� � Permit Fee_ - <br />City, State, Zipl�: �, �, r,Ln c i c ,�C G. <br />Owner (Mortgagor��Zl���/� - 'Cc. /�il-L <br />1 <br />Billing Name ��X�rJ'� 1.�! ���(_�Ji� L <br />7 r' �-- <br />Connection By .�--� u{��� �1�C7.r�i�. <br />Address <br />'[; �� �I ` �l = � Q <br />DESCRIPTION�:y <br />Lot � `f'Z Block�_ <br />i <br />Plat (.. �'i i ., t�� �'.iiJL,�. .`4 'l <br />Unplatted Description <br />Connection Charge(s) <br />,�/ � C c—' <br />Total Fee �- y- <br />� , ,, � <br />; � � <br />; <br />%/ . <br />Signed , �- � r, :',-�, �: <br />.. � ,•customer�� . <br />SEE SKETCH ATTACHED <br />Y�.":'� � n�� P�(�,_{�y � ,,�� � I <br />rp•....". tia_Y. '�`^J_��. �_ I uJ� � i' " <br />Sewer District <br />Monthly Sewer Service ��G ��-'�� Y� <br />Monthly Sewer Constr. <br />Trunk <br />Latera I <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By `— ��C. u=��-� =. <br />City Engineer <br />�ssued By (-. l.�+t. C/i ,,s a� �j <br />�� ` <br />Inspection By���-'-C �9�-<<^-- <br />Date I nspected � •3 �_ 7�� <br />� <br />� � � a � <br />,, y , <br />� fi�as.._<f_+wix •e a�3"�f�tp�+. � -.t'�, r �C. �_;. h a„� <br />