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CNART NO.' - - <br /> everett ' � j <br /> � / � . <br /> City of Everett , <br /> Engineering & Community Services <br /> ' �ewer Apg�liaation and Permit <br /> ; <br /> , N0. ._' .' _ DATE r . ( L i I-..+ � I <br /> i <br /> � <br /> � Service Address +'` ` � �` � " ' '- '� �=�- Utility Account No."--` �-� - `- - <br /> � Billing Address � ' �' � 4 ��� � �� ~ �` `�- Permit Fee "Z-q � U <br /> ���..., i` C`C-' � ( i I <br /> ' City, State, Zip �--�-! uG[=:;T- �t_�G�-� Connection Charge�s)_ ( �-� ��' !7_T') <br /> i c � �"C, <br /> ' Uwner �Mortgagor� l�c= .-�����-� '=� -� �' �/ Z- Total Fee =�-' <br /> iBilling Name ��'!"'•��• , E= <br /> i Connectian By �-�`�' • '--- <br /> � I.;[,., L-s , � <br /> � Address � �- ' ' ,J� � � � Signed <br /> �Cusromer .. <br /> � Phone "�, ', 1 . ��c�,.{ � <br /> i DESCRIPTION: t SewerDistrict�=�-�`' �� L' ��'�--4� <br /> �._S_ <br /> � Lot_ � Block .? . ��> <br /> ' .�, ,., �,-.r_, ��� � _,-�- MonthlySewerService <br /> �I <br /> Plat <br /> Unplatted Description_ Monthly Sewer Constr. <br /> � Trunk f � � <br /> Type ?ermit: �L��., (�C.i1`4:=- , < .�._� T <br /> i -. <br /> ; Lateral '--" ' <br /> � Remarks: <br /> i Abutting Lot Line <br /> � N, S, E, W ft. <br /> r <br /> I - <br /> ! <br /> � APProved By � � ���_,C.���.1 � S <br /> Ciry Engineer <br /> EIssued By ��- =-C ��i ''; <br /> � <br /> i <br /> � [ � � — <br /> � i <br /> � <br /> � Inspectian By c.'�-{-/C :'l,v� �-�— <br /> DaYe Inspected �/� ��7� <br /> ,'• s ��-.- ------ �^' <br /> � <br /> �- - SEE SKETCH ATTACNED � N0. ' <br /> �--`�_rT l� � <br /> ' , ._ _._ ...._ �.�:: �,._ ,.� .,.. .`._...� . < .�.u�. - - - <br />