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everen <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Per�mit <br />N0. � �_ f� t� DATE .%'I "�-' ;'J 7 I <br />t <br />Service Address`t r"J L�-`: ::�/c'�-%�'.J--� r1 LiE:. Utility Account No. -- <br />�1� �..� �. <br />BillingAddress��-'�'J'"' L`r r•`:���"""�� �<.L� PermitFee — <br />� ` , .= v F � <br />City,State, Zip�--"�-'�'�-'rr lL� - � Connection Charge(s) <br />Owner !Mortgagor) � • � <br />�-�7��.:-�.t- Total Fee �-''G'' G� <br />Billing Name ��- � C_-u�GkE=. <br />�' t�tr'�.�i� :, l.I� i:�+! :, <br />Connection By��N�Jr�'"�� - <br />,/ c'- ,j / �; -'" <br />Address%/L. l.JL!C_. /�. ._..til,!/rC.i..cni� Signed � (,r. '�� �::,r''-r <br />— J Customer <br />Phone <br />�.7 r. �', �G �s_. C,e" <br />DESCRIPTION: Sewer District '����''7� � ��"�'� <br />�.- � _� <br />Lot� �.. f� Block �. '� � , �� <br />Monthly Sewer Service <br />Plat V/ C i�i<y r�fE7c,iiT`-� <br />Unplatted Description Monthly Sewer Constr. <br />Trunk <br />-..--�—^ <br />Abutting Lot Line <br />N, S, E, W <br />Approved ByL , "�'�'�•v'�ti�j <br />Ciry Engmecr <br />IssuedBv�' GJG:L.U/J,��t% <br />Inspection By �✓ -"w""''��'"� <br />� . . , <br />Datelnspected <br />N0. �_ : : .. .. <br />