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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />CHART NO. 5 '- �3C%-�=���5✓ <br />J?c, s T'G= 7? L� > <br />Sewer Applicatian and Permit <br />NO. � i j' 1�Z DATE _�r �� <br />Service Address J�� �' �✓�� %:t���t �% <br />Billing Address � 3�%S �"/ a, '=' S. v✓. <br />City,State,ZipL���'/��V��J✓�-� I�d�H. �J�%�o <br />?�� <br />Utility Account No. <br />Permit <br />Connection Charge�s) <br />Y L: ,,-tl <br />Owner �Mortgagor� ��� G/�-- S/..' ,> 7' % Total Fee 3� � <br />Billing �ame s ��'��l 1 <br />Connection ey �)ONiv»'v F'L 1'4, F�% w•-�: <br />Address �C� (/V '�i _�/ rll�� �l/�J�/ Dia��: IZPgign <br />-7 r O�h�•vrTs.�.,17 <br />Phone / Y 5 � vi/Y..�+ <br />DESCRIPTION: <br />Lot Z/b "" �'� Block � <br />Plat L L r•il� ✓ L�'�'R/D �S :/�)7f-' <br />Unplatted Description <br />Type Permit: <br />Sewer <br />Monthly Sewer Service i1� ; r%rZ '' �� <br />Monthly Sewer Constr. <br />Trunk ^ <br />Lateral ~ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By ` �..!`�.f'����: �.....• .'l <br />' City Enginccr i� <br />/ <br />Issued By_�„_���f.(�^'-�•r� <br />Inspection By _ �*�''��— _ <br />/� <br />Datelnspected � �'7 <br />NO. -�"-� <br />