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1 <br />everen <br />eI <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO. 4`1 - - <br />NO. ii r"`, DATE �' i 7 L <br />Service Address 2 le' / > --" Q j 'r Utility Account No. U <br />Billing Address 2-� /� (., q ,•. / 9l, Permit Fee ? 04- <br />City, State, Zip-Z P 't, /i1L7 / ,} <br />Connection Charge(s) D <br />Owner Wo. tgagorl�/� ivL ; i •i /.;" /i / i <br />Billing Name t'L' a,+/if it / GL //!(e" <br />Connection r <br />Phone -> 4,-3 —1 f-Vo O <br />DESCRIPTION: <br />Lot /O Block <br />Plat Hpa ,'A,s AIA, vie« D"� •' <br />J <br />Unplatted Description_ <br />Type Permit: NE FY L. D/v Nd' <br />Remarks: <br />Total Fee 3U <br />Signed__ <br />Customer <br />Sewer District <br />Monthly Sewer Service_- <br />Monthly Sewer Constr. <br />Trunk__ _ �^ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By % //"'5- iv 4, <br />city Engineer <br />Issues By �-_ • , .:. ,l �. <br />Inspection By_� <br />Date Inspected lt77'7 <br />" NO. <br />