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G� <br />:. <br />: <br />everett <br />� <br />City of Everett <br />Engineering & Community ServicPs <br />Sewer Application and Permit <br />NO. � � � �i � DATE / ��� 7�77 <br />� <br />,� %/3 .��'` � � -�' � .� <br />Service Ad�. ess ' '�� -'"L'"'' (`' ` <br />�a ""�r „� .� � � <br />Billing Address _---�----- <br />�� >� —j ., ..k'_-/r i <br />City, State, Zipl. ;- '' � ����� <br />� <br />c . <br />.� �1 <br />Owner (Mortgagor) � � � <br />BillingName ' �` - <br />Connection By ' - - `--� <br />Phone -3�-3'-' L 5 DO <br />CHART NO.����:� <br />f I <br />1�d'ST"r �' <br />2_�t -7 $' <br />� � <br />Utility Account No. � i '- S' � � � � ' <br />U� <br />Permit Fee �/ � <br />c� <br />Connection Chargels) �L,L� <br />,� <br />Total Fee 66 - <br />Signed .�'�•/ � �%�'%��J �I� <br />/ UstOmer � i <br />DESCRIPTION: Sewer Districtt,ir '_� __� �� ��- <br />Lot Block Monthly Sewer Service �—/ <br />Plat <br />UnplattedDescription�,�� " -'y �� ��" MonthlySewerConstr. <br />E KETCH ATTACHED <br />o < <br />, •� <br />�',''' : �, . `lkmr::�: rt�, ` <br />Trunk __�% �-� '�� <br />Lateral ��r � h d <br />Abutting Lot Line <br />N, S, E, ����0 ft. <br />. i'-'r/ <br />Approved By�'._�Ciry �n''gineer <br />i' �' ' <br />Issued By - / � <br />Inspection By � K � <br />Date Inspected �� Z 7 � <br />NO. . .. .� <br />