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everett <br />' � <br />� City of Everett <br />; Engineering & Community Services <br />; Sewer Appli <br />N0. 'i; ,_' - <br />cation and Permit <br />DATE <br />CHART NO.�s ,,,0'r�' 0°� <br />Service Address ��� -� ''/ 1 V Utility Account N <br />Billing Address <br />Permit <br />City, State, Zip ' •='i� Connection Charge� <br />Owner ( <br />Billing Name <br />- f- _-�-- <br />Connection By - <br />1 <br />DESCRIPTION: <br />Lot / ' " �E� Block.-L� <br />Plat � � r � �-.T <br />Unplatted �escription <br />Total Fee <br />' � ��C� CI <br />l � � <br />-� ; c> � �-= <br />, -._� -. <br />-----'�". <br />�� <br />.� <br />� <br />Signed �, . � <br />Cuslomer <br />I SEE SKETCH ATTACHED <br />IN <br />N <br /><'M" �� <br />�..:.i� �`I.Y._+� '. �.:K1ri,] �'�V � n ._.. . <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />La tera I <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />Cny Enginccr <br />Issued Bv • - _ <br />' .r <br />Inspection By '-�<�.�� - - _,.�':n .=�" <br />Date inspected_ . —� - 7 � <br />ap • <br />�' / C •��S .. + ��� <br />T A +h�w <br />