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evere" r <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 21.71 T DATE _ / " <br />Service Address 3 3 —! % / 11- /'L . 5 c, <br />Billi ig Address. i2t2 eslt A Ln <br />C' i, State, Zip 14411�r L w 45 Y Y1 27,r <br />Owne- (Mortgagor( 12dY QL SO N/ TK <br />Billing Name M <br />Connection By <br />CHART N0. /mil i — z Y-� <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s)- b <br />Total Fee 3 J. J"a <br />Address_ %fir). Lo D 7 Signed <br />Cusrnmer <br />Phone 3 ss-- 3f- 3y <br />DESCRIPTION: Sewer District 5� �,'✓r> i1 <br />Lot is Block <br />Plat Monthly Sewer Service <br />Unplatted Description VLtlf r 1// /=i l Monthly Sewer Constr. <br />Type Permit: <br />Trunk L- ZS <br />Lateral ` <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By .. `' •'%��`11 <br />GtV Engineer <br />Issued By. GU' <br />Inspection By^�w" <br />Date Inspected — <br />NO. <br />