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everett <br />City of Everett <br />Engineering & Community Services <br />Sewer �4p�lic�ation eand Perru�it <br />CHART N0. <br />�- <br />, I <br />N0. ,' ; ;. y� ;j DATE %^%%'> > % % _ <br />l:' ' , <br />__ s=�:� <br />Service Address `f --� .= . � �'� � '-1'� "�~ Utility Account No. �% ' =� ��� " �' f� - "�C — <br />n {' <br />Billing Address �U• �'K -•' ir' 7 Permit Fee -� d� <br />,:. <br />City, State, Zip %`� J /- � / 7 / �d�{J. y; .; v (_:Connection Chargels) -� �1 � <br />Owner (Mortgagor) `- �� U��� ��� � �`� ��f �~-� ! ����� Total Fee <br />Billiny Name =-� M � <br />' Connection By `� A N� /= _- '. 1.�.� <br />Address— Signerj \`\ r{� � ,_ � .__. .. _ <br />.. ��,�__ cpy 'm <br />Phone <br />DESCRIPTION: <br />Lot 3 Block - <br />Plat �l/%r �//�vY '�� �y <br />Unplatted Description <br />Sewer District �' '_. __ - _ -- <br />a — �� � J <br />E ;KETCH ATT,aCHED <br />ii.ici"�..- _ �. <br />. . � � . _ ---._ ._ <br />Monthly Sewer Service �� <br />Monthly Sewer Constr. <br />r: . <br />Latera I <br />Abutting Lot Line <br />N, S, E, W, <br />i <br />Approved By �-_� .!� <br />Ciry Enginccr <br />�/• � ' % <br />C �' ii.��rV .' -' � <br />Issued By � --' ' - <br />Inspec[ion By�1�'�c���^�- <br />f�ateln;per,teri_ X/7/ ---- <br />-��"��� <br />N0. . <br />'�� 't , , �` l�� _ ��r � ; <br />� ._. ., � ����.�,: <br />-- — — ns.� <br />