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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO.L�' 3v-'2-�Z'-�J <br />N0. s� �. i j J DATE -� � �C% .'� � <br />Service Address %�' � Z �_� ��" '�7. Utility Account No. <br />Billing Address � �J. ��v �F '% j <br />CitY. State, Zip %� V%%i',j-%,'�liJ }� /�' J�:.'1,� <br />,r} �-� /-f v� 5i<<�r t�, f � �/ <br />Owner (Mortgagor) J " � �� ' �� ��--�=# <br />Bill? ,q f�ame %f l� % �. /< , i i7r} L <br />Connection By S /a i � / = <br />Address � �J�.� �C '% � <br />% <br />Phone �-5�`�.>`,``'" <br />DESCRIPTION: <br />Lot �1 � 3 % Block_�� � <br />Plat t/c: ��" �`i II �/ fa <br />Unplatted Description <br />Type Permit: <br />�a �_ - <br />Permit Fee_ >i) �- / �-, , t, �<_, <br />Connection Charge(s) ;�` <br />Total Fee _ _ <br />��' ?= <br />f,''� (.� / _%�� <br />Signed rit �,G� , ��" <br />Customer <br />Sewer �istrict_ �"� :�; i-r =�� p <br />Monthly Sewer Service_ Jti9i �fn�r (1 <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />�� . <br />w�y <br />Approved By , ��P.�� �r � <br />City Engineer . <br />I,, <br />� '� �n ,� <br />Issued By �.���(;4../�..,� <br />. r 1 .:, <br />T <br />Inspection By ��[<<�.-� <br />Date Inspected���7'% <br />• <br />�} , � c � <br />� �:.t i .l,Vts�al vY.e.i'^� f r,g, •-� Ak,� : <br />