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everc!t <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Ap�Iication and P�rmit <br />CHART N0. %� ��' ' � % <br />N0. `Z �. � u 5 DATE �y�S /%7 � <br />7 � <br />Service Address y�, � /Lr<+./:r._i"' Utility Account fJo. <br />Billing <br />Permit fee / U <br />CitY.State,Zip '`.�. �.i. �% �,�/�� . �'�, <br />�i �'U Connection Chargels) <br />/ � � '�` • % � G 0 <br />Owner (Mortgagor) /.; C ��� .,%f.. :_.c.. �.�.,:.� 'i i•, ..l � U � <br />. /Total fee <br />Billing Name _� :f�^���-�--� � 1 / <br />,.. . _/ C.: <br />Conneclion By '"��!. � �= * • <br />Address_ / 7'�'� /C.' /�`<--: �r r �L �� Signed <br />1 i� ' cu:tomcr <br />Phone_ � /^' 7 -:'/7 <br />DESCRIPTIOJV: <br />Lot �� Block � 3 <br />,/ .� <br />Plat ' ":� . ).F!� / _�%!,�-.r J / �,�-� <br />� <br />Unplatted Description <br />t SEE SI<CTCH ATTACHED <br />— - - -------_ _ � _-� insi�i:ci iorv <br />�--- - -- - . <br />�. . __ . .. ._. _ .. . .. _ _ . __.. _._. __w` <br />�.. <br />,_ <br />Sewer'District <br />Monthly Sewer Service_ �'�� � �- �� �� <br />Monthly Sewer Constr. <br />Latera <br />Abutting Lot Line r, / <br />N, S, E. W,�% c�, ,.% ft. <br />—�i <br />Approved �y ', . ��'G, �... . . _ <br />Cily Engmcer �i ^ <br />/v � .) � <br />Issued Dy_� ��-�...,.. : _c.c. ',•�-,__� <br />nspection <br />)ate I <br />rvo. 2"l �$� <br />�_ .._ __'�.'___._.___'_ _'._ "_...._ _ ' _ _ "_' _ _ l <br />I_. _....._......__�__�__......__'_._.__. ..____._� <br />