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�vereft <br />e <br />City of Everett <br />Engineering & Community Services <br />�( /C T n �i C' t r .� �(� � _ �-c,j -7 �; <br />� � .� G-i3-�;- <br />Sewer Application and Permit <br />NO. r;' � i�� DATE 't.___I-L'�,_ <br />CHART NO.���-2��s <br />=� / c.i� <br />.��s,z_ � � <br />��`'C/ ! C. <br />Service Address =- "-' = �_''�"� � ` ' Utility Accovnt No. " `�-i � ` � � � �' � <br />; �_ <br />�' �� <br />Billing Address ` `� � �' r� �" Permit Fee -" " <br />- � �,': � / c.. �' / lc �L . '� �L ('�.l .:.i �. -i �.. <br />City,State, Zipf- � L'' �_"' ��" ' Connection Charge�s) <br />,. ._...,�,:.�: :.: �-,. <br />;•'< � <br />Owner (Mortgagor( ` �• ' `""' � ' Tota! Fee_ - '- <br />� ' '-- <br />Billing Name � `' `:' i. <br />Connection By - "'"' '- <br />,/ J�' <br />Address � " ,- l i - . , ---- - Signed��. �cr���/�+�.-�� <br />Cusromcr <br />Phone_�_ - l` `1 <br />DESCRIPTION: SewerDistrict` � `-� ^ �-' � <br />t,� \; i <br />Lot' Black Monthly Sewer Service '1��`_ ,-` `� <br />Plat i-' _. t_�.,..� e .. <br />Unplatted Descrip:ion Monthly Sewer Constr. <br />'' �� ` �Trunk <br />I � �� �f% <br />Tvna Pormit• <br />SEESKETCH ATTACHED <br />i'"?R".`r'� '�i� �+ <br />� i CTI�)f' <br />�p��`,,�,� .�:.�x.��.�. , ': � ��4� ..< �, � <br />d �� 1� <br />Abuttir�g Lot Line <br />( N, S, E, W <br />—\ <br />::: . I Z <br />r <br />Approved B � � IL.`..a_:� �.-,.-� <br />Y ^ City Enyineer <br />/ <br />Iss!�ed BY �_ � �t L� � 1 i.l : ����. , <br />Inspection By ��v ���Z�v�— <br />Date Inspected � �" 7� <br />N 0. ., . <br />,;, � a � �dC1� c <br />i <br />�'�FY".-`'A. .. . b'w �'ir':1'�',.. . 'Y�;� <br />