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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />1/6,7- oN <br />-,�- 7g <br />Sewer Application and Permit <br />NO. 2 L. 8 0 DATE I - '/ 1;7 z <br />CHART NO./ -10- ` �'- S <br />Service Address_ c�d �`f ./. - i /� r Utility Account No. <br />BillingAddress ��� ��ll�!� ,�,�fi' — <br />'Permit Fee_ <br />.t. <br />City, State, Zip JQ Connection Charges) <br />Owner (Mortgagor) .'-�_,lc.- 'L�'"!1_+ `�Total Fee____,_ <br />Billing Name <br />Connection By_____- <br />� r <br />Phone_ 7 <� J' - ��(� ;;77 - 72 Tel <br />DESCRIPTION: <br />Lot Z Block- LZQ Z <br />Plat .--- % -/ <br />Unplatted Description_ <br />SEE SKETCH ATTACHED <br />Signed <br />Customer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Latera <br />Abutting Lot Line <br />N• S• E, W ft. <br />Approved By- <br />City Engineer ! <br />Issued By r5 <br />�4�i3�E--i- <br />Inspection By <br />)ate Inspected_ Y/Y/7.P <br />NO. 22180 <br />t <br />