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i <br /> � <br /> C'verett CHART NO.•` �" � '- � �� � <br /> e , _ �, <br /> City of Everett <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> N0. ;' .I / ' t i' DATE �% /C 7- <br /> Service Address�L� ( �.•� +'-_ �/L_( /1/ii...+ U[ility Account No. <br /> BillingAddress �—�'��r���-� Permit Fce ��� /l./f-- <br /> City,State, Zip�—_�..�'"�JT �i'.) l c('/ Connection Charge(s� <br /> Owner (Mortgagor��"17���l.�/J �E-�F'( � TotalFee ����-/'�/�. <br /> Billing Name � I'J_)F'�I_ iJ %`/E_.�"�_�, <br /> Connectioney �,�� 1z" ��=— [= �.��,�� 1% <br /> Address Signed C.�� ( ��_�jC��� <br /> cu:inrt�e, <br /> Phone <br /> DESCRIPTION: <br /> LoL (� B�a�k l:J�_ Sewcr District <br /> Plat /� 'T.���,7,�_� ; Monthly Sewer Service _ <br /> Unplatted Descnption_,__ _ _Monthly Sewer Constr. <br /> TYpe Permit: � �.`/_�/� Trunk T__-- , <br /> Lateral <br /> Remarks �" — <br /> — �Si�IL .41(t'C-L <br /> /� ! � 4 Abutting Lot Line <br /> �L r L Ll. i L, w. c_ , �.�. ,,� <br /> N, S, E, W_ ft. <br /> .� �l�C 4— _�ry... // .. t.��c. <br /> _,�..7's' ' <br /> Approved By L �/�./Z�/v/if/l _ <br /> Ci�y Engmerr � <br /> r Issued By �. �/1!_ C-rJ ,/ J / <br /> e <br /> _ Inspection By �!'-- � .`� .._; t �.� <br /> p ---- --- Date Inspected__ (, .� � '7 <br /> --j—=— '�` —— ---— <br /> SEESKETCH ATTACHED NQ <br /> �� <br />