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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 1 K J IJ DATE <br />Service Address Z/// e a C' F//'- <br />Billing Address � C" ��-E- <br />City, State, Zip ram`4 Q J%% <br />Owner (Mortgagor) <br />Billing Name_ �1/ -�-'J� <br />Connection By ` c"' ta , CC,I-'Gtzr f � <br />Add resL-;r•L:z. -.A 4-3 A�V>-L-4kg C}A: <br />Phone <br />DESCRIPTION: <br />Lot L. Block <br />Plat <br />Unplatted Description <br />CHART N0. t-- <br />/po�d�G% <br />I! <br />Utility Account No. :3" 3 C 073- U 0 <br />Permit Fee ' 00 <br />Connection Charge(s) <br />Total Fee_ ?j0' oU <br />l F U I Signed <br />Custorher <br />Sewer District � % �C>"o ., Monthly Sewer Service e S a <br />_ Monthly Sewer Constr. <br />Trunk I - /` <br />I atnral <br />•z . Z. <br />Abutting Lot l �ne <br />N, S, E, W <br />Approved B / !"%.7VwI,.' < <br />PP V �� <br />City Engineer <br />Issued By L . GAG. 'oAWA.J <br />Inspection By <br />Date Inspected�7 % <br />NO. 2185CI <br />