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�. <br />/l3,`-��. __ .>.y �,;�,., `ti <br />i ;'-io-7 <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. % i (I ;i � DATE �/,�� ��! �/ 'l <br />Service Address � � ' � ' <br />Billing Address._ `% S J ,=,'� /?"C/ ..:.fa:__ . ._,�,;`" � <br />� <br />City, State, Zip . r,'�� ;:!•<. '/ f=0 � <br />Owner (Mortgagor�_ � -��.. %%����.�-� ; � � <br />Billing Name �/� ` <br />� � _:�.r <br />Connection <br />P.ddress <br />Phane 3 j�� 4�f0 U <br />DESCRIPTION: <br />Lot -5 Block �� <br />Plat � � i ? . <br />Unplatted Descriptior( <br />�� <br />�.-'��..��,`,� .�.,�' <br />G ,$' D�Gs � <br />�'-�r���g <br />���� <br />Utility Account No. - - - � • J <br />n� <br />Permit Fee J�U <br />�' <br />Connection Charge(s)__�p5 <br />Total Fee_ <br />�` /I °/� <br />� <br />�� ) � / � r <br />Signed' �. ` / "7 ; r i; . / , � , ./ <br />� Customer � <br />� ' ! � <br />SewerDistrict ,�' °-=.�-. <br />Monthly Sewer Service r-7 • 5 U <br />Monthly Sewer Constr. <br />Trunk :�� =' .s <br />Lateral "' • % �i <br />Abutting Lot Line <br />N, S, F, W <br />�; . - <br />Approved By -' -��-._ . <br />City Engineer <br />r �/ <br />Issued By ^ ' — _ <br />Insper,tion By�Y -G ! 1atw� <br />� q <br />Date Inspected�� %J <br />N0. <br />