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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Applic�tion and Permit <br />�_ <br />N0. ,� 1t�;l;j DATE _ �� (-a ��I-1 <br />CHART NO.�� 7"Z ,� � <br />�/%d S i �'O <br />,_,�-��r <br />�� <br />Service Hddress �f � L-U (--i f i�f-1 (+i� {J il ��tZUtility Account No. <br />Billing Address � �-' < <- �� � � �,�k: �. �-�k` permit Fee � ��V � <br />�v�1,r:1; i'7 =�. <br />City, State, Zip ��-- =--� Connection Charge(s) <br />Owner(Mortgagor) �'��:T���-�i�- �..��'!�l-i�.k=i c_!i TotalFee ��=•^-il-=. <br />BillingName �-�J,,����C_:. <br />Connection Bv L- �''' t- ��' L='�l:�k.Lti" <br />Signed �c_�L �JI�C .� ��� ��(�f� <br />Customer <br />Phone <br />DESCRIPTION: <br />LOi 1i-�`-� �^,-� Block <br />Piat ``-�T ����7 -r�, ��r_v�c=�.,� �-r,�_.v` <br />Unplatted Description __ <br />T.,..e Oo..,,��. A 1 <br />SEE SKETCH ATTACHED <br />Sewer <br />Monthly Sewer Service <br />�Jlonthly Sewer Constr. <br />Lateral <br />Abutting Lot Lin� <br />N, S, E, W, <br />Approved By � ' � I �^� N � �4 <br />� Qty Engmeer <br />Issued Bv �— • �L�--�- �.1t 1�1�1 <br />Inspection By- "-�-� ! r� �v-o-ta---�' <br />Date Inspected_ � �� - � � 7 1 <br />N0. ; � <br />� :, <br />���. -� +5� .c..:s s a c 4�.' <br />