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, <br /> , <br /> everetl CHAfiT N0� -'t1-Zq�-S <br /> � � ��� ���� � <br /> � <br /> ; <br /> City of Everett <br /> � Engineering & Cummunity Services <br /> i <br /> iSewer Application and Permit � <br /> � N0. % � � � , ,� DATE � - 'i_- 7 '7 � <br /> i <br /> I Service Address ��--C I_-( C_..�_�L;��'�,._] <br /> I Utility Account No.___ <br /> Billing Address %�'-> (' `--C.-C..L_�.L i�,�,�� Z . S C� <br /> ( — Permit Fi:r__ <br /> I Ci:y, Sta[e, Zip�-- �•G� L.'-r- '`7�ri'La.:; 1 Connection Charge!s) <br /> I `' <br /> � Owner (Mortgagorl�i_ �-- " : , ti,� _'.�JV<> �. T�tal Fee 'L' S � <br /> I ` --- <br /> BillingName_ `='�-a�.. �� <br />� c__:_ <br /> � Connection By '--'"'•`• '!=_ _ <br /> Address_l z t-: u_�, T r � �Y � (_�� Signed l✓ -� �� , r-- <br /> trti� <br /> ��y C'�� �� U ;� ���slamcr <br /> Phone <br /> I Df_SCRIPTION: Sewer District__ <br /> G Lot �' �' `7' 81ock �t' � <br /> ` Plat— =-�T �� C i �G� �>; Monthly Sewer Service_ <br /> IUnplatted Description_ Monthly Sewer Constr. <br /> I <br /> i Type Permit: , ,, . � ,- � �'l�� Trunk _ <br /> � — <br /> � _ ._ — — Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> — --- N, S, E, W <br /> — ---- -- ft. <br /> � <br />� Approved By �" ��C--�V n, i..., : <br /> � —_--- —__ CilYEnpineer <br /> �ssued ay L c__ti� c_c ,�.� ,c,)a,.,, <br /> � --- -- <br /> I - 7� �' � <br /> I — _ Inspection By_(\� , etl,�_.•�..._i�-,- <br /> � p-- — -- -- Datelnspected_ i�� � f <br /> SEE SKETCH ATTACHED N0 1 I <br /> � � ��,�;i�irli��� : <br /> � ,�.�j .�up�- <br /> � � �dx���+'#71F�'F's'�,+,�z���rr <br /> , :. <br />