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evereri <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />�- ; <br />N0. � r� O �. .� DATE,.:: .i.�- �� �%%� <br />CHART NOy����T <br />�70 5 L�� . <br />.2 3- ��' : <br />- <br />�� , <br />, <br />Service Address_!_S��d��2.,�� ��� Utility Account No. <br />Billing Address <br />City, State, Zip_ _ <br />Owner(Mortgagor) �C=F'� J����f���zv <br />� <br />Billing Name ��CG P,T �� r.����<<O <br />Connection By n�� � �-�-t-`�T <br />Phone <br />DESCRIPTION: <br />Lot ( � Block <br />Piat �. t=..ht�� � Lc.� � �����). C--r�VLr.it.a..) <br />1 �, <br />Unplatted Description <br />Permit Fee �>�' a� _ <br />Connection Charge�s) 485, G� <br />Total Fee J�. � b <br />�/J <br />Signed J <br />Cuetu e <br />SEE SKETCH ATTACHED <br />� I NSPECTIO!�1 <br />,����� �, � "'' <br />�'!� ; <br />Sewer District J� �-,��� -� <br />MonthlySewerService N1�T'�Q�+3 <br />Monthly Sewer Constr. <br />. <br />Trunk � ' L � <br />Lateral 2• %� <br />Abutting Lot Line <br />N,�E, W � �) it. <br />Approved BY L- •�-I �N hJ I NL�_ <br />Gry Engineer <br />155Ued 6y-� -� <br />, <br />Inspection By �:� � <br />Datelnspected „ 3a �� <br />NO. �r �.� �� <br />_ _. , _ . . .;:' -_ _... <br />