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� everett CHART NO.��l4—�0�7 s' <br /> � e ��-�d . <br /> � <br /> f City of Everett <br /> � Engineering & Community Services <br /> � Sewer Application and Permit <br /> ; <br /> N0. � �' i" ! } DATE � - <br /> 2G <br /> � , , <br /> Service Address `J_(c.?4 �C(/[l, � .�i <br /> - r� Utility Account No. <br /> Billing Address � �� `�i;N n�l- ).� `i" �,i , � e�, <br /> ��T— Perrrit Fee <br /> CitY, State, Zip =C.�r�-2.L C .Uu . �1 S Ci(� <br /> Connection !'harge(s) <br /> Owner (Mortgagor) �t..'"�''�!J� ,�'/q��tJGx �;� ,� � UG� <br /> , ---__ Total Fee <br /> f3illing Name �hti�4_ <br /> � - <br /> Connection By ='.t':r�.�t. �i / <br /> Address � \ `�4 � tl[-�, �_ � i � <br /> , r - .�. ,l � <br /> Phone �p^ �T V�� Custome� <br /> 7 -CaGo1'� <br /> DESCRIPTION;, ' <br /> � u � � � SewerDistrict ��E-h'i/�c_,c_ �> � <br /> Lot�_ Bloc< <�•�4 <br /> Plat t� �-- S �`= j_ Monthly Sewer Service f'/C-_7�Z-G..T� <br /> Unplatted Description <br /> Nlonthly Sewer Constr. <br /> Type Permit: ,:,/ �f � �,t ! . Trunk <br /> �.G� �t�wJ �ti <br /> � Lateral <br /> Remarks: <br /> Abutting Lot '_ine <br /> N, S, E, W ft. <br /> _ APProved By L ��_.1 -?!�i.., <br /> City Engmcer <br /> _.. IssuedBy �' `i�LC,i�/.�._i�! <br /> — {nspection BY--1--���,y� ,� <br /> � �—� Date Inspected��`j � <br /> , SEESKETCH ATTACHED <br /> N';I'i_CTlrj�� NO. <br /> � <br />