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tv,= z- <br />el <br />City of Everett <br />Engineerir,l & Community Services <br />Sewer Application and Permit <br />N0. �.LOi� i DATE <br />i <br />CHART NO. <br />4 e 70 )t V70 - - de"W:1- 0 K <br />4 - /,J 7 I' <br />Service Address y& Utility Account No. 3— OV <br />Billing Address Permit Fee <br />3(i <br />' <br />City, State, Zips_ . r c I /LrYL. %,F �G3 Connection Charge(s) <br />Owner ) (Mort a,or - �• %j. <br />g g ��� �-�' Total Fee 30 <br />Billing Name <br />J C� <br />C7n nCCilOn By <br />Address / Signed r <br />Phone 3sS- 6 %G customer <br />DESCRIPTION: <br />Lot Block <br />Plat ✓ 4 - .�tr <br />Unplatted Description <br />r Sewer District �� ',.�./ <br />r-, <br />Monthly Sewer Service_ c2 • O <br />Monthly Sewer Constr. <br />1' 1.9 <br />Lateral <br />w 3 <br />Abutting Lot Line <br />N, S, E, W. <br />Approved Bye <br />City Engineer <br />Issued By tt—' <br />Inspection By <br />)ate Inspected_ <br />n t <br />NO. <br />