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'I everen <br />I''� � <br />I City of Everett <br />Engineering & Comn�unity Services <br />Sewer Ap�litation and Permit <br />CHART NO. � - <br />j �; ;::� '-!�% �C;� <br />, <br />' INO. ���' , i,� DATE �� I'I � <br />Service Address <br />c: �C L��k-C.i�� �IG Utility Account No. �- ``�' "-'�' 1 �`' <br />/ -': i-� . �. v <br />� � Z�C � /C./E !!ij Permit Fee `y <br />Billing Address , <br />C c.. ! <br />City, State, Zip t��-�'L'�- -�`��- �/� C C'% _ Connection Charge�s)_ <br />.•:�,�I�. J�i' 7�l U-7�, <br />.' ,Q � �- <br />Owner (Mortgagor) 1 �- �ii %t i'i � �-'�`� ��'""` " rTotal Fee <br />Billing Name -��' � % " � <br />Connection By -_' %�• �'/ � �- <br />Phone '-/':� `_ - � . (�7 <br />DESCRIPTION: <br />Lot ' = 1 B <br />Sig�;�d ✓ / �- %/G�c.,l� ; l� � ' ✓ �: ._- _ <br />Custamer <br />Sewer Uisti ict �= �'� <br />Monthly Sewer Service <br />� .-��. Ri .1 �-- <br />/� • �, CJ <br />Piat _ <br />Unplatted Description! r� � � � `� � �� � ` � Monthly Sewer Constr. <br />Trunk f ' � � <br />Late <br />Abutting Lot Line <br />N, S, E, W <br />APProved By L". �:.'L ;; l/_ir��-i `/ <br />City Engineer <br />/ / <br />1 C. -� �c � n I! l l_> <br />�ssu�d av � _— <br />Inspection By� �`-"1 <br />Date l nspected���7 �/ <br />N0. _ <br />ns:=--- -,--,.,. �__...� _ --- _ a. �_« <br />