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evereri <br />e <br />City of Everett <br />Enq�aeering & Community Services <br />S�wer Application and Permit <br />N0. � .i � i �) DATE �`�� i � °�� `a `! <br />Service Address � �-� � � �`� �'� ��'� �-7'�-' ��- `� <br />BillingAddress �!ry=�`� ���"v'"�`''L' �� <br />� <br />City, State, Zip �- �"��'� � n'='r> >�U 1� <br />Owner (Mortgagor) �''�� ����-k� �=- <br />Billing Name � ��'" ''� <br />Connection By C=��y"' L- <br />i (s�'t��e..` �l N�� �J� t�l� <br />Address <br />CHART NO " =� • <br />� <br />�a�Tc�'� <br />Utility Account No <br />0C� <br />Permit Fee �1�� <br />Connection Charge(s) �r� vr 'G-1 C ( <br />,� � i.. � <br />Total Fee <br />�. 4 . ' <br />Signed " � <br />c�:tomer <br />i �4 ? - "'7 �,� `:, g <br />Phone <br />DESCRIPTION: Sswe� District �� (�C�0.) r:) � <br />Lot 1"� �-T �1 Block '� , `.�U <br />Plat h`�itiYL6.. i-���4� �l`� � Z <br />Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Trunk ' ' � �' <br />Lateral ( � G `� <br />Abutting Lot Line <br />N,S,E,W <br />Approved By L. • I��-�.%(i/rt-'<-/ <br />Ciry Engineer <br />Issued By � � �fS�'���-�u"J <br />I�ispection By � <br />Date Inspected � "� � �77 <br />� �� <br />� � i. <br />2' � ;.:.r._ ', <br />