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A <br />N <br />0 <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />SQwer App�icatio� and Permit <br />DATE / J '7 <br />,: <br />� <br />N O. ,._ .� C�.. i r <br />CHART h0. '— <br />JJ �_(, <br />�' �' `` � C..� <br />R <br />� �_ /,� . -., —" -.' t_ <br />' lI :'_, L�!,:: ::_, r.� �'%� Utility Account No._ ' -'�" '' <br />Service Address � - ` <br />'U �..�. <br />Billing Address �� j �'�-� ��L- �% i Permit Fee -' <br />i : /t7 c c, / �'t �i� f ,1 <br />City, State, Zip f�-'Z.!_�Jut �IC`�'Q ._ Connection Charge(s) � , - <br />-J � ta G <br />Owner (Mortgagor)�y'� r��`�f �`� �'E`"��'�'� F'ti%`-�"j Total Fr.e <br />BillingName -'�''�"� <br />Cor,nection By � � `'' ' � l \ �• <br />X- 7� <br />Address _ Signed /5 � ������" � �ll `'�" ���"' <br />Custamer <br />Phone �' _�^,- � '.C�'% <br />Sewer District h %� /f�N'� � <br />DESCRIPTION: _ . <br />Lot ��-- ' Block Nlonthl Sewer Service � �" � <br />Y `` <br />Plat <br />� _ � ��,y.L (,%/[-.. ��• Monthly Sewer Constr. <br />Unplatted Description 5 <br />� < < <br />Trunk '' <br />.��' �� • �". � ��-� � �:J�.t[ <br />Y�: K" <br />Lateral " <br />Abutting Lot Line <br />N, S, E, W <br />(__ !.(� ,..; , . <br />ApProved BY ' <br />Ciry Enginecr <br />Issued By 1. �--�! C.� 1� i i; J� <br />c <br />Inspection By - �'��— <br />Date I nspected O�( 7 <br />NO. ,- ' <br />— �iil, <br />