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u <br />8 <br />everett 4 � �. <br />ef <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO. �/ ���-'' '� <br />,.. _ - — , ��� <br />N0. ,� �,;� ; �,'� I DATE � y`'` - � 1 I— — - <br />�ITL� �,p . W, <br />Service.4ddress ������ T �� Utility Account No. - > ; ': ' " ! <br />Billing Address— :' � �' +� % > � Permit Fee 3 '� y'2� <br />City, State, Zip '� }1;,:.:: S%r" �l.= n�.�/(ll 9�} L"X Connection Charge(s) Z`1 %`�' <br />Owner (Mortgagor��QCL���n1 � sr�1 � i/f Total <br />j Billing Name 5/'�/�%'' <br />� <br />s <br />e <br />Connection By 't�/�L�%r�'i � �AJ / i r! ' , <br />J <br />� , :,.;�,. �' ijrl,._. ..., ; <br />Address � �� �o X °"'% z Signed <br />customer <br />DESCRIPTION: <br />Lot ✓ Block <br />Plat t/�.1._;" � •;� t�l;t.�(�f. <br />Unplatted Description <br />Tvoe Permit: <br />Sewer District 3� -st-� �« �� <br />Monthly Sewer Service__-- <br />Monthly Sewer Constr. <br />Trunk � _ <br />Laterai <br />Abutting Lot Line <br />N, S, E, W <br />r, <br />_r' <br />Approved By - '- " <br />Ciq' Engineer <br />� .�,� • -.. <br />Issued 8y__�� � " ���' * <br />/ <br />Inspection By�� <br />Date Inspected 'S y <br />N O. � � � �' <br />r-.�-^s�-�?,:�'"�'.,.-'�.�� �3 <br />