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L <br />j <br />i <br />i <br />everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application cnd Permit <br />NO. �'' �' li "� � DATE ���' �-1�i <br />r -, 1 <br />Service Address -�=' � � �- = '-= �'•� �"2_ ` �,C.,' <br />Billing Address `i� «- �-' -' 1'� � � � '�. �� i_. <br />City, State, Zip'�:'�% �t.' S-'_.; ; � t_ � r. <br />CHART NC �� �'�/ � • <br />Po sT�-�o <br />/-9-7g <br />Utility Account No. =-='} T L��� -�" G' <br />Ur <br />Permit Fee `J�-^ <br />c <. <br />ConnectionCharge�s)__ "I�r c i�'��;ri7 <br />Owner (Mortgagor) ��-'r' � `�---��'`�- �- =C%�v Total Fee <br />BillingName ic:-t�i ��--i�k.�.`:C.,�• <br />Connection By � � � � i�- � E � .-_ , � , �'-c-� • <br />Address �- ti L�c,7 .� :� r i-.L -'— C:_ <br />- :-n..7 �I � 2�� L... <br />Phone '- �, c'. _ ':T�-L-�r' <br />DESCRIPTION: <br />Lot �L�-� Blocl� -' <br />Plat �� �- � i %L �. I �' �,�_,� <br />Unplatted Description <br />�i� C."C <br />� �^ ' % � ' <br />f / ` <br />Signed_ �i r�'��:� G4�f� <br />� Customer <br />Sewer District �--�-�' <br />Monthly Sewer <br />Monthly Sewer Constr. <br />LG .� , � tx <br />'L ,:v <br />I��`�` <br />Lateral -� <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By �'" �1� �'�'V r uL� <br />City Engineer <br />Issued Bv %" i^-:"�-dJi7 <br />Inspection By !�// iR �U-�---� <br />Date Inspected ��/���77 <br />NO. .. <br />�: <br />