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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permii� <br />NO. � i .� � �i DATE _ �� 1 � — <br />/ <br />Service Address --�� �--�! ' � � � �t�- r"R /_� <br />Billing Address � Z�% ��-'E.��i(,c< L <br />City, State, Zip �� L Ck="C-. n��iil .�-Y`' L�:�� <br />L-' � <br />Owner (Mortgagor�F--��:-T � �� /C/!!-'l� <br />Billing Name �C/J�T � • f- /G/1C-�JC <br />� <br />Connection By �� �� <br />Address N � �� / T/i r'"� �.� <br />Phone :✓���•- �t (�C�; <br />DESCRIPTION: <br />� <br />Lot �� /- � � Block �-' / <br />Platr':.L/!-'i i/ �is�... � ,�� �.� <br />Unplatted Description <br />Type Permit: �E�i;/� <br />I CHART NO�w'�I� <br />� �� <br />: <br />/�'� ��i � <br />Utility Account No. <br />Permit Fee <br />Connection Charge� <br />Total Fee <br />?/�-� pG <br />�� <br />Signed � ,-,��' <br />c�:�o��, <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />, Trunk <br />Lateral <br />utting Lot Line <br />N, S, E, W_ <br />proved By_�-J �` rC-/�✓Nric. L� <br />City Engineer <br />iedBv `- C�..tG.ClJl�liJn; <br />,f ,/ 7� <br />�ection By�_�'� ��%�-L-{�.,--'• <br />e Ins-pected �/G���_ S�/ ��7 <br />N 0. ` .� -. <br />f- �V- �.. � .� i <br />_ . ?� �" .`5,1; t ?� <br />