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N <br />n <br />� <br />il. � i . /h /: i � � � � _ <br />� L✓� <br />everett �, <br />� _, <br />City of Everett <br />Engineering & Community Services <br />Sewer �4pplieation and Pe�mit <br />NO. ;, . � J ', .;. DATE : � � �/ / <br />Service Address -' �' / f' i r- <br />BillingAddress '� � � �� -%� � _ � <br />City, State, Zip / , i /`� �" <br />Owner (Mortgagor�_,.� % f:- <br />I Billing Nam <br />Connection <br />Address_ <br />Phone_ = l ' ;`/ j� <br />DESCRIPTION: <br />Lot /�/ Block��" "'' d <br />Plat /'. �i . _ - �f . ,,!j . :/ . <br />Unplatted Description <br />CHART N0. �� .� <br />�oS° � � .� <br />G— z Z— 7 g'' <br />��� <br />Utility Account No. <br />r.� <br />Permit Fee_ ; C� � <br />Conner,tion Charge�s) <br />;i- <br />Total Fee_ 1 U <br />. ���4-rr � <br />Signed—/,, i:-�r.",�: �:/'�i���� <br />us� tfier �— <br />� SEE SKETCH ATTACHED <br />� ' a ,.s�, , ��y , � � , � <br />"x _ _ ' �„' "' <br />Sewer <br />Monthly Sewer Service�__- '-' <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />Ciry Engmcer <br />Issued By= <br />� <br />i� ,�.--- <br />nspection By i � C,l�--.��. <br />)ate Inspected_ �"�/1��%.� <br />NO. <br />�i .s. _ <br />� ' . . x`1:"� � '�`';�1 <br />