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everett <br />City of Everett <br />Engineering & Community Services <br />� <br />Sewer Applocati�n cand Permit <br />No. 22016 <br />Service Address 3 S �' / /% <br />355.� '' <br />Billing Address �-'-- <br />City, State, Zip_;;s � N� <br />,,� <br />DATE Z � 7 7 <br />Ci�y:.e/ <br />/ �/ _./- <br />Owner (Mortgago�r7�_ _�'t'.- �� /�1�-_...ct,d'' �/,'^,sy�-, <br />Billing Name = Y'2y��� �� <br />Connection <br />Utility Account No._ <br />� � <br />Permit Fee <br />Connection Charge( <br />oca� <br />DESCRIPTION: Sewer District <br />Lot /� ' �e Biqck--7 ��-- <br />Plat _'� ��� �%`- -r'f�f�7 Monthly Sewer Service <br />, <br />Unplatted Descrip'tion Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />S� � <br />.. <br />Approved By f, ��-L'r��, c,....,.� <br />Gry En9lneer /' <br />ISSUedBy =J��/��-� <br />nsper.tion By <br />, . . - .. , .. ,. <br />)ate lnspccted � �' <br />�VO. �c��i.� <br />�- �-3?9="�-77 ------ --., <br />