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everett <br />� <br />City af Everett <br />Engineering & Coinmunity Services <br />; Se�r�r A�apl�ecation c�nd Perrnifi <br />NO. ' '_,; ��' DATE `� -�"- <br />,� <br />Service Address ' " �= / ' < % r :' ' �- / <br />Billing Address f �u ' �G'Y ' %G i <br />City, State, Zip /Cl�%� ,1 4 7' � ��<I. j' .��: <br />,.� <br />Owner (Mortgagor) � _ - <br />Billing Name - ,� <br />Connection By -'� c- ..�• _ <br />DESCRIPTION: <br />Lot '� Block <br />Plat '�' � � `• _ <br />Unplatted Description_ _ <br />Type Permit: %_ , � , <br />CHART N0. �� �' � - `-"� - <br />� � '. I c - � �,.;I <br />Utility Account No. .J " <br />:i <br />Permit Fee �v <br />Connection Charge(s�_ <br />- � <br />Total Fee _ :' <br />�/7- d/ <br />Signed <br />Cus�omer <br />--� j ' / ir'�:_. <br />Sewer Distric[ - <br />Monthly Sewer Service � <br />Monthly Sewer Constr. <br />Trunk -= • - - <br />Lateral <br />Abutting Lot Line <br />N, S, E,CLV! �O ft. <br />Appra��ed By _�'� ; ;/ � �� <br />Ciry Engineer � <br />Issued Bv—' • , - / <br />� <br />Inspection By �Z�%�� _ <br />Datelnspected�� _ <br />-.�:,, <br />N0. �� = -; .� ,;� <br />�� <br />. . ��..',._+. .1•-nk .__ �+..�':c, t'.'�� <br />