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everen <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Applicatio� and Permit <br />N0. j:i .' DATE ���I 5 I% � <br />Service Address �'� '•� � �� � � � �•; 1+�111�;Ct-� 6� <br />a <br />Billing Address'�-� � `�" '-��-- { G �'+-� �. � �' <br />City, State, Zip �`' I� .� a�� r�,_� i= F_. �'L-' �'i\� (�_ <br />Owner (Mortgagor) �--L_'�_ } �.—,��'-�E-f.i. i <br />G;' <br />Billing Name `'� ���- %c- <br />Connection By Y==` �'-��'�� � C� <br />Phone ) '� ,-� C % ( L I <br />Utility Account No. � �"� � �-` - <br />Cr• <br />Permit Fee � �-� ' <br />Connection Charge�s) 4 �� � �� � <br />Total Fee "�'� '-� f'., �' <br />� _�._ <br />Signed _ <br />Cusromer <br />DESCRIPTION: SewerDistrict_ " I.: ( ,���'� � <br />Lot Block y P/� t--T;:_:�:: !-- <br />Plat Monthly Sewer Service <br />Unplatted Description Nionthly Sewer Constr. <br />SEE SI<ETCH ATTACHED <br />Trunk < �L C.: <br />��... i C..• <br />Abutting Lot/�Line <br />N• 5��� � (' i --- ft. <br />Approved By <br />Ciry Engineer <br />Issued <br />r <br />�: , <br />Inspection � _ � ./�'___, � <br />Date InspecteJ_ �� �/�- �� � <br />r�o. <br />