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� <br /> everett � CHART NO. � �� - ZS S � <br /> e = � <br /> �,S ;--�. � <br /> �' �?�f . <br /> City of Everett �n ' <br /> U <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> NO. �' ( �.� v :) DATE _ � II �`� I7�'=' <br /> Service Address__--�-� �.`� �—{ �_ � � e,�, u� Utility Account No. <br /> Billing Address-_--�� =-� , �- t „�� ,.i n� Permit Fee `-+-U • L �� j <br /> City, State, Zip � �_f—'k L�� ( (�r� ` ^7C'.� Connection Charge(s) � <br /> Owner (Mortgagor) _ [ P LJI,.' -7-� ru��.. ;= Total Fee �-�-r ! �' <br /> Billing Name�_',�_. _- C -v(-���-_-�-t - - <br /> Connection By_ C--�'= i-' +.- �� � r , � T <br /> Address �-��: �� Z�f�t_ L-�,' 7 '->��L<" (cSigned_ - ' / ���,J <br /> _v , � Cusromer <br /> Phone .� ' ! � ' =. <br /> DESCRIPTION: Sewer District �� L �= �'1+t_ ,t/�� � <br /> Lot � � - � ' 81ock �'"'f 7 <br /> plat �--- �L 1�-�_- 7'T � Monthly Sewer Service- '��� �--��1?_� � <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: �y L� �,c,ti, U� _ , <br /> '�runk <br /> Lateral <br /> Remarks: - - <br /> Abutt?ng Lot Line <br /> n N, S, E, W it. <br /> � (/U50' c`(o NJ rs h(° � <br /> �__ �k �£ 'tc. E{ � <br /> �J . - r -� <br /> ,nn��a�Pd ev l.__. �-1c� ,.��� � N �, <br /> Ciry Engineer � -� —' <br /> ' Issued By �' —, , t t- I! i ; �J <br /> Inspection By __ <br /> a -- <br /> Date Inspected { <br /> SEE SKETCH ATTACHED ��� I <br /> � � . , � <br /> i <br /> i <br />� <br />� <br /> �•- -- <br />