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Iewerett CHART N0. , �7-��?f�_�. <br /> � �.�n � i� ! > . <br /> City of Everett 'S - / � � � <br /> Eagineering & Con�munity Services �`_ .�- /�i <br /> i�ir <br /> Sewer Application and Permit <br /> � , <br /> N0. � � �' 't DATE �- I � �]E'_' <br /> Service Address) J''�'_f'`"_�.-� � �� -•i' l���_�_ Utility Axount No._ <br /> Billing Address �. C''' �� `� �jT� � �:�C Permit Fee_ =_,;L1 C i_. <br /> City, State, Zip I: �C::T,- �t_-1_l�L�-�--�4\ , ` � �^[� �� Connection C6�rge�sl <br /> � l.i Tt�ti. ���..�)� UK'� -��.() (.'(.� <br /> Owner (Mortgayor) .�__:_�__.�' Total Fee _ __ <br /> BillingName���A'.�TGn. i IiC)��•�ti �--C_�J�C�� <br />� �-_ <br /> Connectinn By .:���"''� L. _ �' <br /> - � � i <br /> Addr�ss_L� `7 L'� 4�> i�-� ���t, Signed � %! (��+/ >'�'=�j�' � _ _ I <br /> Cuslomer <br /> Phone �" �-���.�_�4 �P / I <br /> i <br /> DESCRIPTION: Sewer District_ �� �-� ( ) �� � � � <br /> C ' , ) --�- <br /> Lot /. t ��Y Block="-, L_�_ iL . � .0 <br /> Plat_ � - �. �� . ;�_�.� � Monthly Sewer Service _., <br /> � <br /> Unplatted Description _ Monthly Sewcr Constr, <br /> Trunk <br /> Type Permit: _����U � ,,J _t � � � — <br /> Lateral <br /> Remarks: <br /> - Abutting Lot Line <br /> � _ N, S, E, W___ ft. <br /> f ' <br /> � --- r <br /> ( - ApProvedBy�--_f-1-'L' �l...i..)f ti_�[� <br /> Gry Enpineer <br /> — — �SSIIC� By `�� �/S�LL1�F 1 ���1/ <br /> ___ Inspec[ionBy ,('�� '�ic.�.-..� <br /> o _ Date Inspected T��7��i}� <br /> � SEESKETCH ATTACHED Np, <br /> ir: ,i � rii ,� <br /> � <br /> I <br />