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everett <br />� <br />City of cverett <br />Engineering & Community Services <br />�ewer �4pplicatian and Peu�mit <br />CHART NOU � ��" Z � �' � <br />/ D `S%V�^ � <br />Z-��-7g <br />l�� <br />NO. ,' ,: _I. U �,i DATE � �' � <br />� �/� � � v � �.� <br />Se�vice Address. `� 'l -' �� �_a,_,��� Utility Account No. -� "%� - � �U U V <br />Billing Address_�r�� -' `� % � J%� �I�� • Permit Fee �•' �', <br />City, State, Zip�' ' � � � ,_,: �, f t � ' <br />-� � , � <br />Owner (Mortgagor) ( �� � -:��_:��� <br />, / . <br />Billing Name_ <br />c� <br />Connection Charaelsl - ��v <br />/ <br />Total Fee � � <br />Cannection By = r��" ' ' !� <br />> � - <br />Address_ ; �� / �� � i ,/•.� Signed .- -' , ,._�!,_�,-';yr_,-yL <br />Customer <br />Phone '-' : '7- �l .=� _ <br />DfSCRIPTION: Sewer District _ -'�� <br />Lot �� Block - ;, <br />Plat � �- Monthly Sewer Service___ " _ <br />Unplatted Descnouan __ Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />�pTf��--�*.-,�c�. ` ` <br />�r'rinri <br />I -�n-'-` A 1 ui �. <br />� .f, ,.� Y . <br />I_ateral <br />Abutting Lot Line <br />N, S, E, W_ ft. <br />Approved By- %� < -. <br />Ciry Engineer <br />Issued By �` • _ <br />Inspection By_���� <br />Date lnspected /.=��`�/,Z7 <br />r— ir � <br />N0. <br />h 8 <br />cl: '��� � ' h��1 �. <br />.. . _ . . � 4 t. `. <br />