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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. F I;1 i� DATE �� /��/%7 <br />Service Address �� G 1�` �-���F/""-� j/ U� <br />BillingAddress �� �� � Ca1L/,�-C // <br />City, State, Zip/r��i //C�G 7Lt.� <br />Owner (Mortgagor) �J/k�lC J�//�" ( ( <<� � <br />Billing fJame �—��yv/� <br />CHART N(�' �'�Z���T� <br />,�o s �to ,a <br />Utility Account No. <br />Permit <br />� i-i C U <br />Connection Charge(s� <br />Total Fee J�. �'U <br />Connectian ByGE-G'+t-� �-fL�f':� 1C:� � � - <br />C'.f �l-_il� TC:C <br />:. . <br />Address -�-'4 L� %�7� /�/ � Signed `--`Cc•� _.� , <br />� �I � / <br />Phone �� ��f � � ��� % Cusmmcr <br />DESCRIPTION: <br />. � � Sewer District_�,�!!�� �-'�� <br />Lot L -� - Block % �r Cc <br />Plat �. <='6�� >—j' Monthly Sewer Rervice ��L 7LX�:�� <br />Unplatted Description Monthly Sewer Constr. <br />��� r A � :' �` �r�; � �, � . <br />° �,. o l� :, : p,: <br />Abutting Lot Line <br />N, S, E, W, <br />APProved By L . �-��:,�f�✓ii . cr <br />Ci�y Enginee� <br />ssued Bv_ �' r_.. !�ti L l il i,i;���' <br />��..,c� <br />nspection By_��c Sf f a�-c.ez..-- <br />�ate Inspected_ /�3/Z7 <br />i <br />N0. <br />' � ' t.';�'(� <br />R S `K .I �.5�5 <br />