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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. _ _� i. .I .� DATE —i _ i . „ 1 _� .. <br />�! <br />ServiceAddress !--<''- �' _- �".-I 'i <br />Billing Address -'- �--- (' -• �, ( :_ � <br />City, State, Z <br />Owner (Mortgagor) �-- �'���'LF. c i �, � � <br />Billing Name _- � _��'��1�_ <br />Connection By �—I i 4- r_ ..'- L L�� L �� <br />Plione <br />DESCRIPTION: <br />Lot�� , - � i':��`_ Block �� `+ . <br />Plat hil �:v t�i�' <;.•. I'\ , i� <br />Unplatted Description_ <br />CHAR i N6�"� ���� aS <br />f'� s, �.�� <br />/-�e-� g <br />/�`� "iF.. <br />Utility Account No. <br />Permit Fee ' �' ' ' . - <br />Connection Charge( <br />Total Fee � `--'�_-r�-.t._ <br />, J <br />Signed �---�::Lt�_ ',"�I:'C:.:��(li: U <br />customer <br />SEE SICETCH ATTACHED <br />� � � �-,� � <br />� � ,� � <br />_ ^- ;"!;.s _..a <br />� _:. <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By L �-� L t ..,, �� i <br />Ciiy En�incrr ' <br />Issued <br />jA (_ C.. 1 ` � . . <br />Inspection By_ Ln �. �r„at.r�-r.� <br />�ate Inspected � -_�3 — 7 � _ <br />NO. <br />� „ '"""�C" � ,� <br />� j� 3..�5� '-*}, �� �� I.. <br />