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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Se =•= �r Application and Permit <br />N0. _ _ %' � DATE _ I � j 1 �' ...� t._. <br />Service Address_ � '` � ( �G- � � • ���/� �r �:�(-L t ! �� j � � �, U <br />Utility Account No._ "E <br />Billing Address`��-� �= ' � -� �_- i � J� l-.V Permit Fee "✓C% • �� �"� <br />City, State, Zip �'' '<< �. + �� � L�Y�_ ��i: ,'r.\ t c::_ Connection Charge�s) ���f � �` rJ <br />Owner �Mortgagor) k-L-1J (` �� ;`-�t_�,�� — % (`� - �.' !�: <br />� Total Fee ✓ - <br />Billing Name_ �-l_I�.� E` �l J`�i'<r�7�f '� <br />Connection By _^1 f `'`'� � <br />Signed <br />Customer <br />Phone � i '( i r� � t <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description � ` �-��' ' "-�� <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Sewer �istrict �-=�'� .�_ .� � <br />Monthly Sewer <br />Monthly Sewer Constr. <br />l�I,— �--'�� ' <br />Lateral L � � '- <br />Abutting Lot Line <br />N, S, E, �iV ` � � � ft. <br />Approved By <br />Ciry Engineer <br />Issued <br />�/�`� <br />/ ,. <br />Inspection 1_/���l���va�;;� - <br />�� <br />Date Inspected ���-�,�- % �� _ <br />N0. <br />i6aw:� �. �.�._,.. _.,. . ... :.-�_ .>_. . .. . .:, ... � _ . . <br />