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' ' � —� �;' `fN:�" .� . . _ ,/ . <br /> everett � ° CHART NO,I`L�'� _ ^�%- -� <br /> Q �� sT�= � �. <br /> V _ <br /> City of Everett �i � � � � <br /> Engineering & Community Services � � �/ , � <br /> `r <br /> Sewer Application and Permit <br /> NO. '�� � ! t� DATE �- �• 7 rY <br /> � � <br /> Service Address�1 i_��' .-L. •., � Utility Account No. <br /> Billi�g Address � � � �^' ��l%% �•�� �.- J��!permit Fee_ JU G� <br /> :" ' <br /> City, State, Zip_�/ �> .';,,;� �f%2 , /i"D,?L.Connection Charge�s) �� <br /> . ' /� <br /> � <br /> Owner (Mortgagor) f�✓"" � �_ Total Fee � �� � � <br /> �j;, , <br /> Billing Name -'�-' <--_� � <br /> Connection By -��r• , �`,� <br /> ,_� <br /> Address _ Signed..�=���� , ;,�„ '4� �t/f>-1� <br /> Phone- �/Z— 7 i ��� _� j� _ ,,)�G� Customer <br /> DESCRIPTION: Sewer District <br /> Lot_�=j�`_ Block- 3':� , <br /> Plat._' � "�' . _� Monthly Sewer Service oJ• �v <br /> Unplatted Description ___ _ Monthly Sewer Constr. <br /> Type Pernir `.JiJ. �,. % % .- "�— Trunk J <br /> I —� Lateral ' <br /> R emark�,: <br /> Abutting Lot Line <br /> -- — N, S, E, Vy_� � `/.. . ,,/ _ft. <br /> — � <br /> —_-i <br /> APProved B�J✓ /�, <br /> — _ Gry Enpineer � / <br /> �" �� ✓ <br /> ISSUCd B��--:. <br /> Inspection By Q ^uct <br /> y -- -- Da[e Inspected__ ���//�� <br /> SEE SKETCH ATTACHED Nu. <br /> i ��,i i i i� v; <br />