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evereK `� <br />� <br />City of Everett <br />Engineering & Community Services <br />Sevver Applicc�tion a��d Permit <br />CHART NO �'✓ � ` �� �� <br />�,3%li0 `` � <br />�Z- /S�� ? 7 <br />NO. F� �� 0.�5 i DATE �UU . 4 1`'7 i �-- <br />��--- - -- <br />Service Address- � �-'����C: �< iJ Utility Accoui.i i�o. <br />Billing Address <br />City, State, Zip N�ll�1�-�� _ <br />Owner (Mortgagor) "�r:'T , .�"��{�,�� <br />BillingName `J��v�t� <br />Connection By �•� 1'-,' C..=r= �- `'t.'� E77 <br />Address_ <br />DESCRIPTION: <br />Lot � � Block _ _ <br />Pi�c l—��� � 1—� � _� � �=�,�NT��,. <br />Unplatted Description_ <br />Type Permit: <br />Remarks: <br />� ��« a G�� <br />� /,/.+ /rrLA��s� ,`f' / <br />� N�•.� <br />�. <br />SEESKETCH ATTACHED <br />o , �r <br />, . _ r�': • ;�i <br />_ � �wt�:i1 �-`^-��33,� <br />/ <br />Pdrmit Fee ��-'_�_}�- <br />Connection Charge(s}__ <br />Total Fee NOo-��. � <br />Signed `----�L��- �Jf�C��_.t�7✓> <br />c�:romer <br />Sewer D <br />Monrhly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutiing Lot Line <br />N, S, E, W, <br />Approved By �. I-�� �'�l I.,C, <br />Ciry Engincer E <br />Issued By . � � ��-C-!\4;-�a� <br />Inspection By �A-u -� ��-*�� <br />Date Inspected � / - / 7 � �'L <br />N0. ��. "��I <br />INSP[CTION <br />. �- `- -._,_ , , .., � _. : <br />