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i <br /> vrm..� ..... � <br /> e�e�en 1� � <br /> � - - ` : � ' <br /> �_� ,-_ �, <br /> P: . •,S � <br /> City of Everett R � <br /> Engineering & Community Services <br /> �.. • <br /> Se�wer Application and Permit ,..-. <br /> .;. <br /> rvo. 22324 DATE `� f � � <br /> ����.Z (7 •._ .'�.'f'+ �. C,(-:: i ' i;r _ :.i r . � c7 � . <br /> Service Address � �� _ Utility Account No. - a <br /> , r r! (J� �y � ''_' l <br /> �. Permit Fee <br /> Billing Address � y Z � '� � J ' - <br /> ;;,5,�,��� � �-.y� '�j7Jxo Connection Charge(s) �`' '' ~ • <br /> City, State, Zip y <br /> Owner (Mortgagor) `��-t� �r' �+'wr���w �- Total Fee 3Q J <br /> � - , <br /> Billing Name - " - �s <br /> Connection By�,,.. ..,-.-x-.�. �>, ��-,� ' 7 � / �+ '�r <br /> �^ Signed � �' 1' ' ,�.: �:'��:.�,, . : ' <br /> Address c�sco�� <br /> Phone > > 3 - �`/ •�(o ' <br /> � � <br /> DESCR�PTION: Sewer District ='�'"`" '� �� <br /> Lot_�� `"� Block Monthly Sewer Service %� "� <br /> Plat ` • ..�'��.->.�- _ :�.l�i,,, <br /> Unplatted Description Monthly Sewer Constr. <br /> � <br /> Trunk � '`� <br /> Type PermiL --- <br /> _.� � • Lateral \ <br /> . ��f•-.� <br /> Remarks: Abutting Lot Line <br /> �=' �� �/ .t�'' �i�f<! .�.. �. /I< ,,a,.� N, S, E. W 't. <br /> ti I�'.� � <br /> /./ �f� �/ -�'� .1., �` .r. . ':�. 1 �'� ; � . <br /> �-----rj i f� <br /> .t', , <br /> ./' . � <br /> Approved By .,'�v.,..., ,,�ti. ; <br /> Ciry Enginear iE <br /> - --✓ , 9 � t <br /> Issued By .'ti ��::��,� , <br /> � -- <br /> � , <br /> ; <br /> ' Inspection By <br /> Datelnspected <br /> 9 SEE SKETCH ATTACHED NO. 7 2 ��� <br /> INSPECTION <br /> �� <br />