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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />S�ewer Application and Permit <br />-„ , , ;, ' � <br />N0. l �� �. ;>� DATE r�-= <br />Serv a Address �- � _ _. iV, <br />_ t� � ,, c ;,,a ; , � <br />Billing:,ddress -'�'' `- - <br />City, State, Zip '-- � ' `''' � • - <br />OwnerlMortgagor) 1��� r_�,.�.i.., , i.1� ..,� _, 1�..L- <br />Billing Name <br />i.'�C,_1: P.�.t�..t_, i—�.a- �..� i....C� <br />Connection By i'-'�:' � <br />_ �, -� a \ �i.; . � , . � _� <br />,4ddress_- <br />i !�. " � � � 0' t.. <br />Phone - <br />DESCRIPTION: <br />Lot � c1 Block <br />� �: <br />Plat '-- i.: � ,',�. r_ �:_•=- <br />Unplatted �escription <br />CHART N0. " '� <br />Y ^; <br />- �, - ��t> <br />a <br />Utility Account No. ` - � 4 <br />� �, � �, <br />Permit �ee <br />r�: ,� <br />Connection Charge�s) '�`�C� ������` �� `�� ',�� � <br />, <br />cr., <br />Total Fee -���' <br />' � <br />Signed__ ?'_c.ci ��a.Kf' J . ! � �� a <br />Cusmmer <br />Sewer District " � ""' "" " f '� <br />.L , � ��. <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk �� � `-- <br />. . � <br />0 ,� � <br />G :i � 1 <br />� r1 � t <br />t I�:• <br />Abutting Lot Line <br />N, S, E, W <br />i <br />�_ ,.._�C:^.L. i,t_I r r•_. �� ' <br />Approved By . <br />City Engineer , . . . � <br />� / <br />Issued <br />� .] ! ._ L. '.'� .,.. <] <br />� � i <br />.• . <br />�. • .. ., , �� <br />• <br />� '� i� � f dJ 4 : J �t <br />� , e .�" �` x .e,y�.,".�iiF.�..i'.a ` F �7i <br />.1. t <br />� <br />