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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicati�n and Permit <br />N0. - DATE I I� �: ; I-; �r� <br />Service Address �-' C.Z...'� .. � �� �. /`/.�. i (���f'iL,/ � � <br />BillingAddress'!`*-� �' �L•r�L�7��,5 <<� <br />City, State, Zip �"'�'�' �� �n.-7�..i5''��. lc:,�'-f.'.1.Sf C5_ <br />i. <br />Owner (Aqortgagor) � �_ �-'/ •i _i1 ! � : i: .� : i Z- <br />�� _ _ <br />Billing Name_ c /--_ •.� L �,L%;��_i 1r ," <br />CHART N0. �� �'- <br />Utility Account No. I</ C�i( j <br />„ C�� <br />Permit Fee �%�% • <br />Connection Charge(s) ����'• �" ' �� ���i �_rl �<. <br />Total Fee -:��, f � _ <br />Cannection &/ •-. i--. i c- � <br />Address �:1 .1 1 < . � ,� �, ::> ! '- � Signed ' - _. _ <br />Cus�omer j <br />! <br />Phone � r--' a. <br />DESCRIPTION: Sewer District - � - -�' _ <br />Lot Block <br />Plai Monthly Sewer Service ___.___ <br />Unplatted Description � ' . �" % � ( � ' ' � ' � Monthly Sewer Constr. <br />SEE SI<ETCH ATTACHED <br />� <br />i runi< <br />Lateral `� • < < <br />Abutting Lot Line <br />N, S,�E,_ W � " � <br />Approved By _ <br />Ciry Engineer <br />Issued <br />/ f /� <br />Inspect�on v.; :/ i ,,, , ^/ ' Y �f�i , <br />=�---=-- <br />Date Inspected ���% J �� <br />no. <br />