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everett �- � - � 5 <br />� � ' l <br />City of Everett <br />Engineeri�iy & Community Services <br />Se�nr�r ,�4p�lica��on �a�d Permit <br />N0. `��_'�.=;'� DATE '�� - <br />.. i ; <br />Service Address ��` � i'' � - Utility Account No. <br />i <br />Billing Address / - � � _ 1 "'' Permit Fee �`� <br />:�� <br />City, State, Zip �`� Connection C'iarge(s) ^"" � <br />, � � �_^�— <br />Owner (Mortgagor�_ _ � -' Total Fee_ <br />Billing Name__ ' -- <br />Connection By__. __--_ <br />DESCRIPTION: <br />Plat <br />Unplatted Descr <br />Signed =r.. . %� ' /' r' .c...,.� <br />/ Cuswmcr '" <br />% � J — .' i ri '�� <br />Se�ver District_ -� �' � /1-�� <br />_ BlockT,_ '. S U <br />- sj Monthly Sewar Service ^ <br />� — — <br />�� Monthly Sewer Constr. <br />� <br />— Trunk - • � � - - - <br />SEE SI<ETCH A i 7ACHED <br />i;�a� f �c i�ic�� � <br />Abutting Lot Line <br />N, S, E, W, <br />Approved Ey �' �� <br />Ciry Engincer <br />Issued Bv _� . --- � '' <br />.• . : � ��� � : <br />.� � . <br />d );:; �«a � <br />� . �.� � ti r �.� �� ��r �; � � , � Y ��,'-�S �:. <br />' i' �. "� . r::� • ' . .�... _ "�i. <br />