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eD <br />City of Everett <br />Engineering & Community Seivires <br />I <br />Sewer Application and Permit <br />No. !_'t' 1 r_i ( DATE Z/�ZAV <br />Service Address <br />Billing Address <br />City, State, Zip' �/, .V_`.;. _t., ILt_ �� f i 7 U <br />Owner (Mortgagor) L T a . <br />Billing Name k -T (—c <br />Connection By ) C- c <br />r (1-_1 , t, 1\L. N C <br />Phone (t `- 'j - / 1. 7 ' 1 <br />DESCRIPTION: <br />Lot Block <br />Plat _ • ,.„e L e_L t.. J\o,: <br />Unplatted Description <br />Type Permit: (�c L. (. k t c, , r, ., <br />Remarks: <br />CHART NO. _1tz/=1L��Ar <br />Utility Account No. - e, (' - ' ( --f., C, <br />Permit Fee__ Ci <br />r� <br />Connection Charge(s) I( ('' r I. <br />Total F <br />Signed <br />Customer <br />Sewer District C_= _ C r...I <br />I <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />l runk <br />Abutting Lot Line L <br />N,IS, E, W_ <br />Approved By! <br />City Engineer <br />Issued By <br />Inspection By <br />Date Inspected ��� <br />SEE SKETCH ATTACHED NO. <br />