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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. !_.L 1U5 <br />DATE _ %7 <br />CHART NO. /q_—z9—Iz— <br />M <br />Service Address_! � 5 (/['.��(/ 0 Utility Account No. _ <br />K / -1y,a / <br />Billing Address! Permit Feey✓ t' 1 64-'N .7stty) <br />City, State, Zip I eJ1f /77 rthtlwaJe'v.1-4J36Connection Charges) <br />Owner (Mortgagor) S 04 i1 Total Fee <br />Billing Name!5.4 k to n10 /,/ <br />Connection By 1'C1471 11113,crr'LCc1',2, <br />Address i 3~7 �' 7� t/� idlJ f/1i� Signed <br />PhoneCustomer <br />__ �� � � � �� <br />DESCRIPTION: Sewer District_ N0 iz i r1 <br />Lot _' Block_ S J J� <br />Plat �/��Z'-1 ii Monthly Sewer Service <br />Unplatted Descript <br />Monthly Sewer Constr. <br />T <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By ��':�; K y <br />City En ineer <br />Issued By ,>r56Cy J <br />t. <br />Inspection By—/— '� <br />Date Inspected-S��__ <br />r. <br />rao. <br />