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evereri �a/,�T��R,n--z <br />t � � <br />p �1�.!,��:.�:�;�� ��� �;�ti <br />� .� ) <br />[I_, <br />AU G � � 1??8 <br />City of Everett —....- - ._ <br />Engineering & Community Services CITY Of EVERETT <br />Engin2eri�,�� Dept. <br />Sewer Appliccation and Permit <br />CHART N0. " � ��� � <br />���'`i'-�-/// : <br />. <br />NO. � 2't iJ J DATE -_��r ��� <br />/�' %'!:l�_. � �2 %Y res���; t %u <br />Service Address�Y�d� � r l Utility Account No. <br />� Permit Fee " --`--'— <br />Bitling Address <br />City, State, Zip <br />Owner (Mo <br />�-z�-�7i <br />�� . <br />� <br />Billing Name <br />- i- � <br />"(�..t�-r � <br />Connection By �—•�' _ - _ <br />� .,.,.,... � <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unpiatted Description <br />Connection Charge� <br />Total Fee " <br />, /Signed , 1 r -; _1 .- <br />Customer <br />� <br />SEE SKETCH ATTACHED <br />f � <br />r .t�� .,.."_,_ .. . . _._ _,__'. �,., ..a_, <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />La[eral <br />Abutting Lot Line <br />N, S, E, W_ <br />_„r=--�� . �,� � <br />Approved By � "� "�!�=—�� ' -' i <br />Ciry Engineer J, ; <br />.-o. <br />� I <br />Issued By � ' _'--=�""�'� � ' <br />I <br />Inspec[ion By ���n--.��cL'-f--- <br />Datelnspected � � 7 J <br />� �• �.r: ...- <br />