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1 <br /> , <br /> everett /� � �; - .. � �, -" � <br /> � � I , <br /> e � � , � �- �� ,-: �, ,,;:,,;�_ <br /> ,��,�� <br /> City of Fverett <br /> Engineering Departmen, <br /> Sewer �pplication and P�ermet <br /> No. 210 :� ]. DATE <br /> � S I q �u �,� �'<<-,� CCi,',/ <br /> Service Address Utility Account No. <br /> Billing Address Conner.tion Permit Fee <br /> City, State, Zip Connection Fee a 33• /o <br /> Owner (Mortgagor) LI NGpI. �v �I R.S�f �� �— Total Fee <br /> Billing Name <br /> Fo ri F i3ii� /iu c <br /> Connection By <br /> Address Signed <br /> Customcr <br /> Phone <br /> DESCFIPTION: Sewer Disirict � �i �_ <br /> Lot <br /> Block d <br /> Monthly Sewer Service <br /> Division or Addition Monthly Sewer Cons[r. ���r.�( <br /> Type Permit: Q <br /> Trun!< 3 �o � � /��PKS <br /> Lateral �/ � Z y <br /> � <br /> Remarks: � �r �,o.v� di�E As GF.�' S�' >� � <br /> Abutting Lot Line <br /> r _ �' .. N S E W � �G ft. <br /> C:G. I'�u/ iw nev! ' �o - i✓ <br /> UrE ✓u[ L✓o C.�Y. <br /> p��, Approved By_ <br /> City En�incer <br /> Issued By _ <br /> � �/ <br /> i i <br /> I nspection By ,�%'f�� �1����C' <br /> Date lnspected ����.� <br /> 3 -�" � <br /> SEE SKETCH ATTACHED NO. ' f ! ' ' <br /> i <br />