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�verett <br />e <br />City of Everett <br />Engineering & Community Services <br />Se�n�er A►pplication and Permit <br />; <br />CHART NO. �' % `� �' � <br />-- s -' <br />� � <br />�- �i � i', ; <br />NO. i ;;I'._ GATE <br />- ; <br />ServiceP��dress �--�� `'� G-:-�;__c -ri �. , UtilityAccountfJo. <br />Billing Address ��_� �`- %�E_ �` T Permit Fee <br />�- :::6-ZF3-OOU <br />, . c.� <br />� ' � �U. c� U <br />City, State, Zip f f=-u�V(1 � l � �� . 1 4� t��r Connection Charge(s) G <br />�i.� �^�� <br />.�� i� , ' i - C ,` i � 3otal Fee �`' � <br />Owner (Mortgagor)''-'r' -�'' " �' "� ' <br />Qilling Name / <br />�L, �. _ .. _ . . <br />� Connection By �= � < j- <br />i, r' l LU <br />� <br />Address�G't;� �>Z.-°�'• � <br />jPhone � _.� � - ��( S �7 <br />N <br />DESCRIPTION: <br />Lot � �' `� Fllock <br />Plat Ui.7_u_�rr l-�; E C� <br />Unplatted Description <br />�..._ � � <br />-' 1 � �. <br />Signed _� F /Il�,� Lc ��/ ^�' J�' � t� <br />CuStomer <br />Sewer District �<<' ���''i-��� � <br />Monthly Sewer Service �' � "� <br />Monthly Sewer Constr. <br />Trunl< � � S . <br />Lateral -� ^ <br />Abutting Lot Line <br />N, S, E, W <br />ft. <br />Approved By �_ �-I`.: �J<<! � � c. <br />Ciry Eng�neer �- <br />. � <br />Issur.d By : �' ' - '�"' r <br />�,/�i % •��� <br />Inspection By ��/ �=`�'�" "�^ � <br />Date I nspected�� b�� 7 <br />N0. <br />._ _.__ � � <br />