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� ^ Zc� -�-��-s <br /> CHART NO. �- I <br /> ( everetl � - �Lt' �-� Z.y <br /> e , _� � <br /> City of Everett <br /> Engineering & Community Services � <br /> Sewer Application and Permit <br /> N0. c� _I ,' '' f, DATE , _I , i � f -- <br /> - I `-1 I <br /> �—�r <br /> Service Address�-� Z� �����'M=' Utility Account No. I <br /> Billing Address <br /> zl z,`� �1-..-"'UrVL Permit FeP_ �Jp�� <br /> City, State, Zip� v��t-1�" C� d L C� ( Connection Charge�s) � <br /> Owner (Mortgagor���-�• � � ��E--NI i TZ Total Fee ��- '—� <br /> Billing Name �--���U Q• ��N� � ` Z— <br /> Connection By�T�'� �� �v���r <br /> ��LaL � <br /> Address Signed �.�c E�'�SI`.C1Y"� <br /> Customnr <br /> Phone <br /> DESCFIPTION: ,���Q Sewer District _ <br /> Lot � �J� � d Block.�— <br /> Monthly Sewer Service _ <br /> Plat �/I� 1.���_DTf`� <br /> Unplatted Description Monthly SewPr Constr. <br /> - Trunk _ <br /> ' Type Permit: �,��q� � <br /> Lateral <br /> Remarks: , - �.i <br /> - Abutting Lot Line <br /> �� r,,� �- N, g, E, W ft. <br /> n/ � �/ • <br /> � .�p� <br /> �__L��n��.r.,�1/1 l���'ti / ,� �, . <br /> ��-� rn ' h�T L . / I�;u�ur ,� <br /> Approved By � <br /> Qry Enpmeer <br /> --- Issued BY� ' �)� UF� ��'J <br /> Inspection By�+u� 7.��� <br /> _ Date Inspeded :� - lL—�7 1 <br /> 9 ---- ..___ <br /> SEE SKE7CH ATTACHED N� � <br /> ir, � , � , <br />