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everen <br />� <br />City of Everett <br />Engineering & Community Services <br />CHARTNO. v._1- <br />,� - , �/7� i 7 <br />Sewer Application and Permit <br />NO. .' � ! " -' DATE � --� -- L— <br />Service Address � ' ' � � �'� ��'= =l- /' =% Utiliry Account No. <br />Billing Address_< ? `�/ � �� `� ' � <br />% '! <br />City,State,Zipl�r.1/1/✓i�(l�y L�•�� '14u7J <br />Permit Fee '�•%' <br />ConnectionChargels) �/,l .aJ <br />Owner (Mortgagor) �' � f/���/� 1 ih�. Total Fee <br />Billing Name �--.a.Ili <br />Connection By i�il/ Jd/ �J.V� �'9. __ <br />Address %� —1 �� -� 3T S r' Siyiied_ <br />Phone_�t�� 'L y'�v <br />DESCRIPTION: <br />Lot �'? _ Block � <br />Plat � � / r; ; 'j.ii✓i 1 "<'.i d` = <br />Unplatted Descrip[ion <br />Type P4fR11[: <br />1 <br />Cuslomcr <br />�, Y <br />/ <br />Sewer District_ �' '7 rl �� J � <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk / / i <br />Lateral "" " <br />Abutting Lot Line <br />N, 5, E, W <br />Approved By �'�'» ,* - <br />Cny Enpmeer <br />. f ` , <br />i <br />Issued By �- . ��_::t �" %" <br />� <br />t. <br />Inspection By—� �._c. .�' '�`� ------ <br />Date Inspected___� SJ ZSJ� <br />l l <br />N0. <br />