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;�'�i1f)��::r ll—;:—�� <br />� <br />1 eVel'11 <br />, �f <br />� <br />� City of Everett <br />i -- Ena�ineering & Community Services <br />f �evvpr Application and Permit <br />, <br />,; �, <br />N0. ;> �_ l J J DATE <br />Service Address ��"� � '� ' ��"' "`� �� �`»' °N <br />BillingAddress G �!� y C�i �e,r=.:;✓��.,�-v <br />City,State,2ip /i✓��l"�� `�/�S/�f •i1���, <br />Owner (Mortgagor) 77 /��cJC-�= O�So�d <br />Billing Name } � j�� <br />Connection By '�!'-'" � � <br />Address� <br />Phone > J'' - �/ ,� � <br />DESCRIPTION: <br />Lot ��' ' - Block � ` <br />Plat _'^ � — <br />Unplatted Description <br />T��.n Pcrmit• <br />—�' 7 �) _ <'— <br />CHART N0. X' ,S —`—" ,�? <br />/ oS�Gr� � <br />� <br />Utility Account N <br />'i_ . �_ ;• . � <br />Permit Fee ��' � � <br />7 ,. , �h 3 . <br />Con�ection Charge(sl `!� .3 � �'`s�`''''�r��" � <br />Totai Fee �� ,� <br />--- _"'� I <br />/') � <br />Signed �I ~ Lc� ��� �'�y <br />/ Cusmmer <br />- �� /; .; ,,. �J �y ��. <br />Sewer District % <br />� � :1 <br />Montn�r 3ewer Service � � <br />Monthly Sewer Constr. <br />. . � <br />'r q � �F�, ' � �� c gf,,�:7j j��.•�, <br />G °`i 1 � Y.� dl : i� '�'n'°v`�.... <br />;� I <br />Lateral ' � 'S� — <br />Abutting Lot Line <br />N, S, E, W, <br />,,� <br />Approved By -� � ,/.�%,'.., ..�, _.-. <br />CityEnginecr l� <br />� . ',9 <br />G J <br />;��sued 61, % �L� � <br />Inspec <br />Date I <br />�� <br />�, �. , •.� . <br />S� A�€. a i �Y ry`-k� <br />�� � i1" ti �� " Jr ., e a 1E .,.� . <br />0 <br />