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everett <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 21707 DATE 3 - -7 y- -r7 <br />Service AddressiJ�f <br />Billing Address ZO3/S <br />� y� ,may <br />City, State, Zip_ (i4- v -? p ;G'o ./ <br />.r <br />Owner (Mortgagor) ti <br />Billing Name <br />Connection Bye�n <br />Address —�/ �L� J c <br />Phone_ 3 <br />CHART N0.—C T � ��6"— <br />Utility Account No. z % 4/ Lt J <br />Permit Fee -. O, —v <br />Connectior Charge(s).SSA. r� (fir,, / 3yy „a <br />Total Fee <br />SignedCustomer <br />DESCRIPTION: Sewer District_ <br />Lot_ / Z Block <br />Plat —4tef-4 6x i�_.W'W Monthly Sewer Service 3 • S�J <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit: <br />'SEE SKETCH ATTACHED <br />jr4SPECTIUN <br />Trunk /a <br />Lateral I. z V� <br />Abutting Lot Line t <br />N, S, E, W <br />Approved By : � y ', <br />City Engineer / <br />r lot (� <br />Issued By — <br />Inspection By....r. L : , • ..-. <br />Date Inspected -"Y-3,Z77 _ <br />NO. <br />