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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />S�dver Application and Permit <br />N0. ��_iC�J DATE > '/o- <br />Service Address 3^t/� . '""'�'"'"" ,:.-' "r`,J" ,�t.-' - <br />L/Y:f � ,'✓ � 2�'�l�l�., <br />Billing Address <br />City, State, Zip �:'�T �'.'. i,-�-d ✓�</ <br />-.. , <br />Owner (Mortgagor) '�� — <br />Billing Name � E-� / - <br />n�n ,'� �l.,y <br />Connection By ��J r��"' = �•� ' '' l ""`��" `"" <br />Address_� �^ v "'� <br />rG/F� ; . <br />Phone �' � =� - % 1V O, <br />DESCRIPTION: <br />Lot �_' - ` � Block� <br />Plat -x �"' * � <br />Unplafted Description <br />Type Permit: L;.�:,�_ ,r <br />Remarks: <br />CHART NO�� SO�Lq 'S <br />t <br />�o s ��� <br />� <br />Utility Account No. <br />/ j�l <br />Permit Fee r" <br />Conn�ction Chargelsl— <br />��� <br />Total Fee <br />- ,: <br />: ,`.�r_.`».._.,� <br />Signed'� ' - � <br />�Cus�omer <br />SEE SKETCH ATTACHE <br />INSPEC�-IC1N <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Latera I <br />Abutting Lot Line <br />N, S, E, W_ <br />�. � (�,���ti�� <br />Approved BY <br />Ciry Engmcer <br />IssuedBy � � �i"'�-"`��� <br />Inspection By—���G `"u'�� — <br />� <br />Date Inspectei l �� 17 <br />' - -�r r�. i 1 <br />NC. (, .,' i �., �, <br />� `" ,�.•.�,�'+�. '��. v ,:'"��•"y�.. �'� - <br />