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<br /> '' �'-1 ° A �t 6- jz- 7S CHART NO.�g�'_.c�.
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<br /> I City of Everett �
<br /> � Engineering & Community Services �� 2q�� �
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<br /> Sewer Application and Permit �,�
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<br /> � NO. `�' '_ !.i �j �J DATE � �/ � /� -� .
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<br /> IService Address_ ',;/,� L',�,�} � ,,, �� Utility Account No.
<br /> i Billing Addrezs_ 1'."�u �1i _ �:. Permit Fee__- '2�i u�
<br /> ! / . ,,lr, :. :',,,ds�N/!% "= �
<br /> � City,State, Zip t-v._=.;::� ,,;,. « y �• z, / Connection Charge(s)
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<br /> ! Owner (Mort a or) l ', t r -;+�_ �„- ,i �=�
<br /> 9 9 r %,F� �r%> Total Fee_ �/ "
<br /> ' BillingName- ��.�:rt%
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<br /> � Connection By �:;� ��A .� ;,,�c 1 �• :.,�i C'o I .
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<br /> � Address i% � {r�, x ,,Yy•:� Signed�-_i / ' �
<br /> customer � „ .
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<br /> Phone ; i�- ;:�,L.i _ _ :!, , cti. .. __ ,
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<br /> ; DESCRIPTION: Sewer District '
<br /> � Lot �- .Y Block_11!
<br /> i P�at �. . „ � � � , ;� ,� Monthly Sewer Service "
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<br /> � Unplatted Description _Monthly Sewer Constr.
<br /> i Trunk
<br /> Type Permit:
<br /> � Lateral
<br /> ( Remarks:
<br /> � �� Abutting Lot Line
<br /> � .h��..., tf'p�y ��;� . ,_ ' z:��'.� - - N, S, E, W ft.
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<br /> � A�proved By • ' ��f'. , .
<br /> citv Eogincer
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<br /> I Issued By��f�:�.,
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<br /> � /n � .�,�.__
<br /> � Inspection By �u= /--r-�'a=2-+�-.�.----
<br /> a - Date Inspected_1 �-/ �� � �7 7
<br /> SEE SKETCH ATTACHED N0. ,� ,._ l; �i �:%
<br /> � INSPECTION
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