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everett I _. .. _ _ <br /> I <br /> � : <br /> City of Everet: <br /> Enyineering & Community Services I <br /> �ewe� �4p�plicat��r� and Permit ' <br /> � <br /> 22271 ' '�' ' - - <br /> N0. , DATE - ----- - ------------- <br /> /. <br /> Service Address � r ' � - � ' ' - 1 Utility Account No. <br /> ��i � " t �-�. 1' >._ � �, ' ''.r� <br /> BillingAddress � �- � `�' ��- "!__ PermitFee �G ' <br /> City, State, Zip t-- . �- -' �- i � , t ` ' : Connection Charye(s) __ <br /> , , - <br /> Owner (Mortgagor)' /,r/ ;;,, �_ ' i : '�. i� _ � ,:; r_.. . <br /> Billing Name ;, ii_ ., : 1_ ;� � c i �,_. -- <br /> Connection By ": � . -��- _ _. <br /> , <br /> Address �cl_ i; _ ( f_i. C_%1L��- ��L Signed_- �� r.-,�. _ ;'.y�-- � ��� <br /> � _ � <br /> _ 7 7 �Cu:romer <br /> Phone � <br /> DESCRIPTION: SewerDistrict ��, � �' �I�C-���� <br /> Lot � � <, Block � �S r <br /> Plat �-_- �_. GL-'i� N, Monthly Sewer Service __ <br /> Unplatted Description _ �4onthly Sewer Constr. <br /> Type Permit: �--. . ;' '�'�,. � Trunk <br /> Lateral <br /> Remarks: <br /> Ab�rtting Lot Line <br /> _ N, S, E, W____ ft. <br /> Approved By � ' .� -- <br /> Ciry En9mr:r <br /> IssucdB � - _ it ;I: � : . <br /> v-=�----- - - - --- <br /> — — i- <br /> InspecUon Y-- -- <br /> _ __. _ _____________�Date Inspected <br /> 3 __ <br /> INSPECTIOh' <br />