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/- " - T7 <br /> eve��tt , � CHART NO,���3�.� <br /> � �'� z3_ZP:s <br /> City of Everett �✓ �'� , <br /> Engineering & Com:nunity Services ��� ��g <br /> S�wer �, � � <br /> pp6ication anc�' permit , � � <br /> � <br /> 2 2 G;; n� <br /> N0. � L DATE //- :•.. Jr' + � <br /> � <br /> Service Address � � I 1 <br /> �� 5 � 1.:..--._- . �;. I <br /> - lltility Account No. % <br /> E3illingAddress�%�O �/,? frj �j,�` .�. / yy <br /> ' Permit Fee ,,� <br /> City,State, Zip . =f - %�/� � „`,...� � <br /> , �' � ' �� 7� Connection Charge�sl <br /> Owner (Mo;tgagor) - " a`:' _ — �d ��f , <br /> � _ Total Fee <br /> Billing Name i <br /> %� <br /> l ' • • i <br /> Connection By _- '� � <br /> ,��_�_ � � � <br /> � � <br /> , � ��: , <br /> Address �(/ � � � <br /> � Signed.��_ lc��.`_��/�/�/r,4r ' <br /> Pnone ��� �/_ X .>h � c��ro�„e. <br /> i <br /> DESCRIPTION: � <br /> � Lot > -_ l,___ i=_(-_ - � Sewer!)istrict j <br /> `, Block_ �_�� � <br /> Plat��°___ .,`G'_ Monthly Sewer Service <br /> Unplatted Description � <br /> Monthly S��wer Constr. ` � <br /> Type �ermit: ":,j. , � .. Trunk /, � <br /> � ._�,f_-- lr .�„� + <br /> -- C�r`%:�, %' -_�� Lateral � <br /> � Remurks: <br /> i <br /> Abutling Lot Li � <br /> � N, S, E, W ft. ' <br /> � <br /> — �,� � i <br /> Approved'��y_ ',:,�� ' <br /> `—��'Y Enpineer I <br /> �' I <br /> /u �� ��'� / � <br /> — tssued 8y__'r� ._____:.•-- �� <br /> � <br /> -- � <br /> — Inspection B ` �p�� ' <br /> ---- � �' '�/T <br /> ° — Date Inspected_ � JO ' <br /> SEESKETCH ATTqCHED <br /> �"�'�5,�1 � NO. ` ;-� <br /> ��� INSPECTION <br /> 4v41Jy11ke t> ..'vFfi�:.��� j2 y <br /> . _. . . .._ . i��y .V 9}�_i <br /> . '.�.II . Y �a'1 4 , <br /> 1 <br /> i <br /> i <br /> l. — _ L._,_._ .. . <br />