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�i r ,,, G k.�-.r % �.c%�g � <br /> � CHAR� � �'� <br /> everetl � <br /> � _-�-. i1 <br /> � _�'���' � � �� , <br /> _> � <br /> -,' - � � �i <br /> , _ -� _. <br /> City of Everett i /.�" <br /> Engineering & Community Services � � <br /> Sewer Application and Permit � <br /> I <br /> �-/ , < <br /> N0. �� `, ' � , ;' ; DATE ! l._ �I � -- --------- -- <br /> Service Address �'�•�l�G � '� �� —'"`��� / Utility Account No. <br /> , / •�. O. [sU <br /> Billing Address� t� � 4 `—'� /`"'='' '"�' /� Pennit Fee •—� <br /> City, State, ZinC •- �_'��L -1) .Jc�`'�-' � Connection Charge�s) <br /> i/ �� /%U <br /> � TTC. _� _. <br /> Owner (Mortgagorl --.. ' �ir�L ,t/niY('ir /E_ ,1_ Total Fee—_.__ <br /> BillingName ���« ��� /�N/tX�.`.LX.J <br /> Connection By ��G/ � :i_ �(J/'.G_!%(.✓t._� �� -� �T� <br /> � �;� <br /> Address ��-,z� ���'` �S i (rG . S. � U Signed., �: , ;' --�-`�- <br /> � �C ti � j Customer <br /> Phone � ��� ' ����"? — — � � <br />� DESCRIPTIOy L � E �I !L L 7 Sewer District "' `��� �"�� , <br /> Lot`--'l L' � " ` T 81ock ¢'/ � ' � <br /> Plat �/T. �.�/G:i!r� _, ra 4 � <br /> Monthl�� Sewer Service �,' ' U <br /> Unplatted Description_ __ Monthly Sewer Constr. <br /> Trunk_ _ <br /> Type Permit: I�I� -(/ �'��,UC17�C .C/ <br /> Lateral <br /> Remarks: <br /> _. -- Abut[ing Lot Line <br /> N� S• E� W------- ft. <br /> — / �i <br /> l . ��J E.Li.c:>/,c.�C ' <br /> -- APProved By �.__ <br /> Gty Enginaer � <br /> — Issued8y �_ �''�u-/���'�� <br /> -- Inspection 8y��� '�!�� <br /> ---- — ---- ---- Date Inspected�l!� 6 �Q_ ----- <br /> o-- _ _ <br /> __ .. __ __ <br /> — _ - <br /> SEE SKETCH ATTACHED NO. <br />