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everett <br />� �� <br />City of Everett <br />Engineering & Community Services <br />� Sewe� Application and Pe�mit <br />I N0. ; � �I_ : �: �;_ DAT�E� " ' � � <br />, � r=� [LGti{. ,•'- /. <br />Service Address i � z ----=s-� :'??= � h i� � <br />CHART N0._ [/� / � - Z,Y� �-- <br />//�] i T r_' �� ; �• <br />� <br />Utility Acr.ount No. •S- �%J ' `i _-'/ - `- � <br />Billing Address "� Y' �,"`J :% ?ermit Fee � J. YO <br />Ciry, State, Zip Lr�i�. � S>=ra�r�i i/��f;/1 fY1af Connection Charge�s) %"��! `� J <br />Owner (Mortgagor) �I� �' � UAi �NI I T"K Total Fee �'7 � <br />i BillingName `=i;�f.�: <br />�'� Connection By ��ri L J✓1'� 4� SI1i/T"It� <br />i <br />� Address l� J f'.� x S�/ i <br />i <br />Phone 3 � v �� - <br />DE5CRIPTION: <br />Lot �'�'S' Black <br />Plat �'I,i. ir_'.:S f11i�';i/ur� <br />Unplatted Description <br />Type Permit: <br />� <br />r' <br />_; <br />Signed . �� , ,':/::'_,. ;_.-i_ <br />c�,���„�, <br />Sewer District z ' � <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Tru <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />y _, <br />/ ��.�.;��..� i <br />Appraved By��l ,�'",_r.a-y.�� <br />Ciry Engineer . <br />♦ ( <br />i <br />IssuedBy_ Z. �,T�:•'.w.''� <br />Mspection By � � �' � G-� <br />Datelnspected s/ �Z /7 % _ <br />i <br />NO. <br />' r .P��� X ��.r�rL�� �..A, .. <br />