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<br /> ��
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<br /> ' �, CHART N0._� — l' .'3—'ZSZ'�,�,
<br /> 2vereti .
<br /> �4 a n . �f
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<br /> City of Everett
<br /> Engineering & Community Services / '�
<br /> 7
<br /> ����r �►p�licat3aaa aa�d P�a�ana� �_.-_
<br /> No. 222� 1 DATE _ '=-�l�al�r�_'
<br /> , �
<br /> Service Address ' �`� % �- =''�=-r-�'�"��=� � ����'; Utility Accaunt No.
<br /> BillingAddress ' `= ''-.�• �., �.. i��cL. r� ��r l.(�'„�alfi�-Permit Fee ��� t-���L
<br /> City, State, Zip -�'--='���; �-� ��-'�� ���'�j '>�� ConnectionCharge(s)
<br /> Owner (Mortgagor) }� �`=-� t" �—: ��-�=' Total Fee t�iL' "�L
<br /> r-� .
<br /> Billing Name ��1���r�_
<br /> Conn�ction By
<br /> - �_�i i�:, c:�:;- '�:_i ,:..�L�.r_��-•r•
<br /> Address Signed r�--���-: ��1(..! �, {-� G �. J
<br /> � ;�'> � �+�
<br /> Cuslomer
<br /> Phone
<br /> DESCRIPTION: Sewer District
<br /> Lot Biock
<br /> Plat Monthly Sewer Service
<br /> Unplatted Description �- �•�-�'�-• r-�t=- `�v- N�- ��L- Monthly Sewer Constr.
<br /> c� _ �-^.
<br /> - _ -7_ ;. , :�
<br /> Type Permit: }` ,-- � _ _---���k _
<br /> 1.—.-L• ti._, �, e:.=.i... :� _
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<br /> ;�''� � ateral � ..._�-- ',:il
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<br /> Remarks: C �-.L� � " . � �� r'. S 7�d
<br /> �'� "� � Abutting Lot Line
<br /> �J� . -��- ryz�i.�.. � . . N, S, E, W ft.
<br /> � . - J . i
<br /> cG � a 7 , .
<br /> _ -�� 2
<br /> _ -_l1_�� �'' c„ � ,�-: ��, t,- ; % i. �.
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<br /> �, i ... � r � � �,�r�.. • �I�� :. / . i '. � :.. J APPfOVBd By_ Ciry Engineer •! i
<br /> ;) "�/ � � / �- I
<br /> IssuedBy `— r- r\LL �;l1 +��J I
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<br /> � � � `
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<br /> � � Inspection By� �%''-1»�-�.�-�+-�; i
<br /> f G�' �
<br /> � � Date Inspected_ �3 `_ � % � 7 � i
<br /> a •
<br /> SEE SICETCH ATTACHED NO �L Z G :. j
<br /> . .n � w,�.. INSPECTION .�,,.�,,,,:.,,.,sf,,,.
<br /> k�" _ � �' � ! -. "a S�T�.��w�'.M,2' ', .1��f�... � c._:, 1.... p��' .��.1.._..�.�..k.i�.��.. �
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