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' everett I CHART NO. � — �� <br /> � �o�-�t,j; <br /> �� <br /> City of Everett '�` <br /> � Engineering & Community Services <br /> , <br /> Se�ve� Applicatio�n and Permit <br /> , <br /> ; <br /> N0. _ '' '. r' � DATE '/ �i I%`.'�. <br /> � Service Address �' �� " %1 �" � �L -' rr ��r . � �-4� Utility Account No. �� �� l- �`-/ �- L / <br /> i <br /> : � � , �•�- <br /> Billing Address'"��� � � ='�� Permit Fee �� � <br /> � City, State, Zip `'`��/L /L 7�G, L��h Connection Chargels�_��"/L� C C,�`� � ��l�i <br /> I Owner (Mortgagor)�`' ri:._,,� �/%C/C-..J,I.i/L.f_;� 'i(` i..�J <br /> Total Fee -� <br /> Billing Name �� � '�_ ��' -�L.�-�; <br /> ' Connection By � �-','�C �'=' G ��""`� � <br /> � � // . <br /> Address�'= T /J r �U � • 1/ � �� % � <br /> r: /� --( � /`/, T; <br /> � Signed 0 i <br /> { � ' Cusromer <br /> Phone ' i- ,; - % '_ 1, 7 <br /> I <br /> DESCRIPTION: Sewer District�� � :� �- � � � � <br /> Lot ' `' Block ` <br /> ' Plat I _� � :. ,- - r � C- i r ,. �'i�C �_ Monthly Sewer Service�' %; �. � r. . �--- — <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk �- ��' <br /> ; Type Permit: _:' /f_;i; G�: �r.�.eJ(..� Ti c. aJ — <br /> Laterai -' <br /> Remarks: <br /> �___- Abutting Lot -Line <br /> N, S�E,:W--� ��' ft. <br /> ' Approved dy �. IIL..,•'_. �.i/. �, <br /> Ciry En�inecr <br /> Issued By � �. �_1G_[ /; � ,i �_.� <br /> lnspection By '✓ �"�� _____ <br /> i <br /> - _ Date Inspected_ 2 S �' <br /> ' — - <br /> SEE SKETCH ATTACHED N0. , . �� :: <br /> ` _ , �;;; I'i i;l l��f <br /> ; � � <br /> � . �{. t � 1:':: <br /> _. _ ,. ,�>� - •..� <br /> . . . .__ ar+.u.,._. .._ . . .. <br /> I <br />