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everett cHa,RT No.= _ � � <br /> � �� � � <br /> //�- � � G� <br /> , <br /> City of Everett <br /> //�i � �.� < --=.. <br /> Engineering & Community Services � ' ` <br /> ��� �� :f /\ � <br /> Se�nrer Application and Permit ' l <br /> I <br /> NO. _ :� „ ' , DATE _ ! � I (, I 1 '- I <br /> Service Address � �+ � _ � � ' � � r=�I _ Utility Account No. <br /> Billing Address�l-� � � : ��. �1 �r.�� �.�1�, Permit Fee J.C:� C. �. <br /> City, State, Zip t- -`-�t._ i:' t:_.i 7 -'�^ 11 ' Connection Charge(s) <br /> Owner (Mortgagor) � �t-1< r�:� ��,�: � ( �;;e � '� _ Total Pee � <br /> BillingName { � k=.-i•_ti.�� _,,� Vi ':.'_� Ii:�L_ — - - -- - - --- <br /> Conneciion By � �-�t:--1<-tlT ,'�/��G�! �c • <br /> Address ":� `iC -� ;�r-�� � -r�� <br /> - Siyned <br /> ` �i ?. ' _, rj,� Cusmmer <br /> Phone - <br /> DESCRIPTION: SewerDistrict �-��- k` �r6:-�-Ji � <br /> Lot 1�-, <� I l.c. Block � � � � --- <br /> Plat �-- ` `�-l< c-..iT ���� ' MonthlySewerService ��%�E=.��=���t'_ <br /> Unplatted Description Monthly Se�ver Coi�str. <br /> Trunl: <br /> Type Permit: �'�(�C U - -- - ----- -- -- <br /> �,'_ n.�tiJ�.L i� C'�--' <br /> Lateral <br /> Remarks: <br /> nhutting Lot Lin� <br /> _.. IV, S. E. ��'�-- - - — - --- --�t. <br /> � -, <br /> � <br /> ApProved By �- 1 ' <br /> c��v ,��i����-� ---- — <br /> Issued By ` � �) L L r� l � <� ; <br /> / � <br /> Inspection By G-�-c>l- : _ _ <br /> � — Date Inspected `� i %� <br /> S�[ SI(ETCH ;,Tl"A.CI{ED <br /> i_ <br />