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D <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. % 196 7 DATE _ �� <br />a <br />Service Address / 5_ c1 ~ C <br />Billing Address <br />City, State, zip t Vie •.'r= Y 7-�V4.45,A '�j.'u <br />;r — ? <br />CHART NO. �Z�zy'" 1 <br />,A-7© S7W'2� <br />Utility Account No. ? - U ( - ?�J/ - oy <br />Permit Fee 30. " <br />Connection Charge(s) 'P %U <br />Owner (Mortgagor) ✓cr- Total <br />Billing Name 'pia; ),l G <br />Connection By -j+r , "y.J.<'w."c <br />Address 2,-0 1 ")y "" ST. <br />Phone 3S zl - -Ycl 7 <br />DESCRIPTION: <br />Lot Block <br />30 b-0 <br />Signed <br />Customer <br />Sewer District_ 1 ,�'✓ L <br />Plat _ <br />Monthly Sewer Service l ` <br />y ,) <br />Unplatted Description Ly 1% 13 ! J ti Monthly Sewer Constr. <br />Type Permit: Trunk r ' <br />Lateral Z e <br />Abutting Lot Line <br />N, S, E, W <br />Approved B7 <br />City Enpinoer <br />l . <br />Issued By�/*i _ <br />Inspection ByX-2! C✓ <br />Date Inspected /�'l77 <br />N0. 2,1( <br />1% <br />