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rr E <br /> CHAH'f T10. ��Z'� Z��a � <br /> everett ��J _ _ ,� ��� <br /> � � c:, �,._ c�. . <br /> f,'� biE <br /> �"�' =:( <br /> City of Everett � � � " r.;r� <br /> .... <br /> Engineering & Community Services , <br /> ; Sewer Application and Permit <br /> N0. [ 1 E � � DATE ��/lif7 � _ ' <br /> Service Address � '='G�� � �a��'`�y Utility Account No. <br /> ! Billing Address ��� /-��/J�l����`` Permit Pee 10 �}� � <br /> I City, State, Zip�L�E.Y�1T `-7� � � Connection Chargels) <br /> � V(.IJ T�j�c,c? c,P�?J�J UU/L I� `�u I, <br /> ! Owner (Mortgagor�' �1�[al Fee � <br /> 1, BillinpName d��- <br /> ; � - �y c�ci�o�. �J ��_. � ` �'� �,.. I" <br /> Connection By�=-�-���-n <br /> ' Address�S'd Z �ii i 7I� Signe��/ ,i"""'",+`'��(-�=�a��:Z{f . M <br /> ' cu omer � <br /> Phone �L �-' z � ' � ,� =' <br /> � I A <br /> I � ' <br /> , DESCRIPTION: Sewer District ,�. <br /> /�l �• <br /> � Lot . ' 4 B)ock GCl S j5 r, Monthly Sewer Service <br /> Platt_- r�E:'T �J�-�� � <br /> Unplatted Description_ Monthly Sewer Constr. <br /> i <br /> ` G� Trunk <br /> Type Permit: - <br /> ' Lateral <br /> i <br /> Remarks: <br /> Abutting �ot Line <br /> ' -- N, S, E, W ft. � <br /> i <br /> i I - <br /> I <br /> �' APProved By ��. ��,�,i,:s_);�J! <br /> T <br /> i - Ciry Enpineer ' <br /> ' L �vu ��i.��� <br /> i Issued By <br /> i i <br /> — r � <br /> -- Inspection Byti-� �-f z".t-- i <br /> Oatelnspected � I �� 1 � <br /> � Q <br /> SEE SICETCFi ATTACiHE!0 NO. �' _` f � �- <br /> �,� ItJSPECTIt�N I <br /> � , ��'�: •� _ , ,r_ � <br /> � <br /> J � <br />