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everett <br />� <br />City of Everett <br />Engineering & Communicy Services <br />I Sewer Appli <br />E <br />� <br />cation and Permit <br />i � � i � �--� � <br />N0. ; i ':.�� ;; � DATE <br />��i « J � /�,�) �U't_ <br />Service Address <br />l Uz_ k .��Y �,� �� <br />Billi�c� Address_ <br />� tJ � ' ` j � �Z C �� �� <br />City, State, Zip � <br />,C_1 r., c, /��/� L.��(IL� j. <br />Owner (Mortgagor) <br />; _>%�-/�/l E;. <br />Billing Name % ` <br />_ ��7} i�.i c. <br />Connection By <br />; C: �7 -) � �✓'t��ZC� C.:�.�U' <br />Address ' <br />� � - , IrC�C.� <br />Plione -- <br />DESCRFf-jfION: i�- <br />Lot �LI�ock <br />.._ �_E.. <br />Plat <br />Unplatted Description <br />Type Permit: !�'..:' � ' � � <br />Remarks: <br />H ATTACHED <br />CH4RT N0._/l-52�•�-� _ � <br />/`�5��� <br />�� f� �7� <br />�I <br />Utility Account No. � �' <br />Permit Fee <br />`.� .� <br />i <br />Connection Charge(s) ; <br />c...: <br />Total <br />Signed — <br />cus�omcr <br />Sewer District _ <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />J <br />Trunk <br />Lateral__ <br />Abutting Lot I_ine <br />N, S, E, W_ <br />,�: � -- <br />_ _ -�� <br />Approved By <br />� �` ��`-- �='r-- l rz� l � � <br />Qjry Enginecr <br />� � <br />- i �. i i_ _ ,' J i � � . _ <br />Issued By <br />i � <br />InspectionE3y � � �� - <br />Date i nspected r � ��7� <br />• <br />I . . f! `f : ; � �� :.,�. <br />�v_..;_ 1�'�._,.'sk"`, y � . <br />