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fv-] <br />LNI�J <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 2 t / ;, 3 DATE 4- 1 k 7-7 <br />IF I <br />Service Address��L Z l luW <br />Billing Address <br />City, State, Zip�- <br />Owner (Mortgagor) <br />Billing Name _ <br />Connection By� nr Cj,= <br />Address <br />Phone <br />CHART NO.,dO—r— 3 <br />Utility Account No. <br />/ <br />Permit FeeyE�� <br />Connection Charge(s) <br />Total Fee �Jcta 1 <br />SignedC--Gr'-1L &VzcsS11T110 <br />Customer <br />DESCRIPTION: _ Sewer District _ <br />Lot `�. ' ,� Block Monthly Sewer Service <br />Plat <br />Unplatted Description. Monthly Sewer Constr. <br />Type Permit: 2CRiji z <br />Remarks: <br />A <br />2-1- lc' /1/ <br />�A 1 <br />A <br />Is <br />Ir <br />I <br />Di <br />Is <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk <br />butting Lot Line <br />N, S, E, W <br />Pproved Byt • � �ir�� <br />City Engineer /r <br />wed By (._/J &Z p/JA7A�l <br />ispection By a' z�a� <br />ate Inspected �O — 7 <br />No. 21733 <br />