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,y�441 <br />everen bW c-ka' <br />City of Everett <br />Engineering & Community Services <br />:-7 - i2 1 <br />Sewer Application and Permit <br />NO, L 1 I. �I 4 C, I DATE <br />Il <br />Service Ad ess - <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) t- ` LO <br />Billing Name �- t l—c' <br />Connection By L •I- <br />Lu <br />Address U Li'Ul Lc: 1 Z 1 1 ia..� tilt✓ <br />Phone 0 9 -• J u t cf <br />DESCRIPTION <br />Lot ✓ Block <br />Plat ..�L1 r•tkt_LuC <br />Unplatted Description <br />CHART N0. <br />Utility Account No. ' ' C6- 1I_4 C) I <br />�U C. C <br />Permit Fee <br />Connection Charge(s) <br />IUU uc <br />Total Fee <br />Signed/w•- <br />ustcmer J' --- <br />Sewer District CJ 4`1<- &" I '> T- <br />Monthly Sewer Service r"� Tf= Ic(✓t <br />Monthly Sewer Constr. <br />Trunk V -Ly <br />Type Permit: <br />Remarks: Abutting Lot Line <br />N, S, E, W <br />SEE SKETCH ATTACHED <br />Approved By t • / %`-/IV <br />City Engineer i <br />Issued <br />Inspection BY���� <br />Date Inspected�� <br />NO. <br />