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City of Everett <br />Engineering & Community Services <br />Sewer Application and Pern�it <br />rvo. 2��i90 �a-r� <br />�ART N0. /� `��--� <br />� q <br />� � <br />�... ,U � � <br />�w► t� �t' L<" <br />�n � wf <br />� « a^� M <br />� -=' - <br />Service Address ��e�_G�.�-��{i, �i� ! �. . i,-:r.�,Utility Account No. .3 — 3S- 5 / -r1- D / <br />Billing Address���2i v2 Sf�_5 v /Pennit Fee. �� � <br />City, State, Zip�-+ C'-- �.�� �`�(rn,�j Connection <br />Owner (Mortgagor�lyC—�-�J---� C.OrL� <br />� / ✓ <br />Billing Name�/ /r=/�� - l___. ? _ <br />/c / � J <br />Connection By.�.ei %�. ( �e��T �/ ' <br />� <br />Address_��• /?J�"%� �S�SlJ - r�'' <br />3 �65�- s3ov qFl/a5 <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descripti <br />T...... fb.....i♦ <br />Total Fee <br />a <br />Chargels) o�. Sys ,.�D <br />--� _ 6cj ' <br />C � <br />Signed�Cl �tivly��`^=',-V �(�idV —,. <br />Cuslomcr <br />Sewer District 3 S �� � <br />Block -�=-- � <br />1�1onthly Sewer Service---=;z��G�'� <br />SEE SKETCH ATTACHED <br />Monthly Sewer Constr. <br />Lateral / `1�. S � <br />Abutting Lot Line <br />N, S, E,Q 3 9Y ft. <br />Approved B • C�� c>C� <br />iry ngincer `/ <br />�v ���SSUCd BY (%X�^r' �c'� S / <br />��Sj)CCI�O�I <br />CllS�v�v!GR G�.Ji�'� <br />NO. �, � <br />