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everett <br />e <br />l:ity of Everett <br />Engineering & Community Services <br />S►ewer Applica�io�� anc� P�rm,it <br />NO. � ,� � % �i OATE � /� ~�--- <br />,, : � j - - . <br />CH.4RT N0. �= '�O- 2� ' '� � <br />1 ; <br />}� �y� � <br />,� � � �-cJ ' <br />�/�t���� ' i <br />G�« � � <br />Servic� Address ^("� `�_ <+✓ Uti ity Acrount No._ <br />Billing Address Pe:. �it Fee,_" �_ • - - <br />City, State, Zip Connec[ion Chcrgr.�s1_ _ <br />Owner (Mortgagor) — <br />Billing iJame _ <br />p - �- • <br />i <br />Cannec;ion By l .r'�i. � _ <br />/ - js <br />Addres- ' — _ <br />Phone._ _ <br />DESCRIPTION: <br />Lot Block—__ — <br />Plat -- <br />Unp!atted Description _ <br />r..__ �___:.. _ <br />Total Fee�_ '__'_ <br />i / <br />Signed! �=_ "'I <br />Ci tlomer <br />a <br />, .� � <br />1 f " r�.a y};� �, rY1�5 <br />�.5...._. . �� __.nl c�' 0.� a��< S,..d. ':fti <br />S�:we� District_ <br />Monthiy Sewer Ser <br />Momnly Sewer Coi,str. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By � — ,�l =>� :-, r_�-,.._� <br />CIry EngineEr ,/ ' <br />Issued BY '"=� =:!' r _ <br />Inspection <br />Datelnspected_ � � ! ` � <br />• <br />i <br />; 't. �,: <br />