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i <br /> i <br /> i <br /> � <br /> • .- . � <br /> � CHART NU. �"Z��C"� <br /> evereft <br /> � /��s/ �v � <br /> � e ; <br /> � 2 Zf - � � � <br /> � <br /> - , <br /> City of Everett /I<' +I �,/ , <br /> � Engineering & Community Services '�� ' <br /> i Sewer Appliceteon and Permit , <br /> ; � a <br /> � , � <br /> � NO. ;: _� .1 :� DATE !'C%/�I-•�� �`7l � <br /> � Service Address�7 L7 �l�l:'�i_���:r-�P� Utility Account No. � <br /> � $ � . Ou <br /> f Billing Address�l�>�=� 4�7 . � /���[_. Permit Fee � I <br /> � / � � <br /> ! City, State, Zip._-Y »r�z�' �_E/O . /�� � Connection Charge(s) A <br /> � Owner (Mortgagor) ��7/\'�� f:F'f'!-l�7'rft:=� Total Fee � �.�. � G j <br /> BillingName_��Z.�i) ��L�i I <br /> Connection By /��/A_'��« ' <br /> C " ' I <br /> Address�l/'Z� C .-.�Ti� � � u Signed`� '�. �_ - <br /> cusromer <br /> Phone �-�`��' k �3 7 <br /> � DESCRIPTION: Sewer District �/G'7'i��:cJ/� <br /> I Lot � — � << Block L��, C7 <br /> � Plat_ �i.iC-�'�7"7— Monthly Sewer Service ��/�7�7Z.�7'� <br /> ` Unplatted Description Monthly Sewer Constr. <br /> � Trunk <br /> Type Permit: /�,/C � � G 'S - ' ' <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> iN, S, E, W ft. <br /> � <br /> � APProved By� � /�7�-�AJ��tJ� — <br /> City Enpineer <br /> M /� <br /> Issued By • C�i� u��N->�ti.J <br /> � <br /> i <br /> �I Inspection By �`� �� <br /> �f p Datelnspected � » <br /> SEE SKETCH ATTACHED Np, `�` ;� � � �1 <br /> � INSPECTIOf�I <br /> C � ' <br /> j �'_ �I�`Jd�l� _ . <br />