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A <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sew�c Application and Perrnit <br />N0. �.. �'. j��' � DATE _`� �� �! ! 7 <br />Service Address2 ��� ( �-'��'UC�r� � — <br />Billing Address�-' ��\ �%��T'" ���" S LU <br />City, State, ZipE��"��=�'� `� <br />Owner (Mortgagor�`�'� �� �I Ll ��p..� <br />BillingName J�t�t,.., ,G.tL� ��ti <br />Cc�nner,tion By� �`-�Nu�!�- � �'«"�- <br />AddressCiZ�V �-J�ZyZ�1� ��� <br />Phone <br />�1�,��� "%�L,O <br />� DESCRIPTION: <br />Lot Block <br />�' Plat `�•�� h"�'t-t�G•�n <br />� Unplatted Description <br />/'Jj <br />CHART N0. b�; `� �-b�=�' <br />�-C � i :.--7^� <br />i � , .. <br />Utility Account No. '?� �� 5' Q' "�- L' v <br />�- ' L1.... /1 i-� C) U <br />Permit Fee�'�'�'- _�`� <br />Connection Chargels) �=�`'��• e,U ��a.�,kyhZ <br />�C7 C�C> <br />Total Fee <br />- . ,, <br />, , , �,, <br />, / �y. <br />Signed %.Z�e.�_..avf '_r�%� .....�i�c..�-^-'- _ <br />Customer <br />� �"-� <br />� Type Permit: �}»tS..-ft � �„r � G• '� <br />i <br />I <br />f <br />Sewer District 2�l �-��"� � <br />Montl�ly Sewer Service f`�T"���� � <br />Monthly Sewer Constr. <br />T.��..4 1 � � � <br />Lateral 2 ' 2' � <br />Abuttin�g` L�ot �Line f U� <br />'�y`-, VJ � <br />Approved By �-- ' ���N� � <br />City Engmeer <br />�SSl1E:C�By �' �l�irC-l�lihl� <br />c <br />Inspection By�_.� �'�� � <br />Date Inspected /p�Z,7 --- <br />N0. �-_ .'. i c_ �) <br />� , . _., ., r, <br />� <br />1'� <br />