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t <br />, <br />u <br />c�crett <br />,e <br />C ty of Everett <br />Engineering & Commimity Services <br />Sewer Application and Permit <br />NO. .' � � - ., DATE ----`� -- — <br />,� <br />Service Address. ;' �' ��J 1 �%� �L� <br />, , <br />Billing Address ',� /�' -�'�*;Y > ��� <br />City, State, Zip '� .firr =vG. `% 4. 7✓ i <br />Owner (Mortyagor) ��.,-�+�-?�'��d-r%��._ <br />� Tj �•r <br />Billiny Name /32� 'Yl L+� <br />Connection By f�-t9'r� <br />Addre <br />Phone <br />, -� <br />ICHAR'i NO._: __ -__ __ <br />i . �> �J <br />� <br />0 <br />� <br />�. <br />UtilityAccountNo. �" �'� "� � L ' �-''� <br />Permit Fee .J' �• '"`� <br />Connection Chargels) S'v' '� n �'� ��/�I � % . <br />�z .- i--� <br />Tot�il Fce- - --- 1 -- --- <br />Siyned <br />DESCRIPTION: Sewcr District �_'�� __ �=J'_n-� � ___ <br />Lot Block <br />Plat Month�y Sewer Servicc <br />Unplatter' Description_ � .�/ .` � ,9 _� ;1 r � '.%1 � � Momhly Sewer Consti. <br />t <br />� Tvne Permit� <br />Trunk— . --- -'-- <br />I ataral L ? 1� <br />Abutting Lot Line <br />N, S, E, W (t. <br />i ��q� <br />� <br />ApprovedBy '� %'�.'s ,r+at.� _ <br />City Enpinenr � <br />' ��� '�'� .. <br />Issued Bv_.�---- 1`--,!i i:_c. • — - <br />�7,/� y <br />Inspe�tion E3y �(Y'�`'4��,1 _ <br />Date Inspected_r}����_ <br />NO. <br />