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everett CHART N0. � "Z�� � <br /> , <br /> � i�� ��-- 1 <br /> City of Everett � �����,�'� �;- � <br /> Engineering & Community Services I , <br /> Se�n��r Application and Permit <br /> I ; <br /> � <br /> N0. � L J J `J DATE �`/i / j �'„' � ; <br /> ' � — �_ — -- � <br /> Service Address Gi D .>?O /j� i. ,�/cJa����I ��. Utility Account No. "' � � ' � `� � ; <br /> BillingAddress / .� S !i�c ,/•' r= f ii'� / J(; ��' � i <br /> Permit Fee <br /> City, State, Zip h �r �c E ;� r� c�Fn/::, Qb��;� Connection Charge(s) f��' � ��� ��`� �/�'(7 ' <br /> f <br /> Owner (Mcrtgagor) �J !�P F n � ; ! .� .ct �v. �� � ' <br /> Total Fee <br /> ( i.; , - —- _ - <br /> BillingName - ` I k(_- ::,.�� . ,� .� �-�y.. ,( <br /> I <br /> Connection By_ '- a .�-� � " <br /> Address � c_ `-, ���:�v� �`., �,.. <br /> � i7 f <br /> Signedy�� r.'. %i:��.tc`-~'\i' L� �{.�'._ <br /> . , � .. / -7 � Cusromer —'-- <br /> P�lOtl@ �_�.._ Cf / C.. L.. ' � . . <br /> DESCRIPTfON: -'�� l :;�: �;, , Z� <br /> t - Sewer District i <br /> Lot Block `- <br /> Plat �. i ; _ ., :-� ,,� �4 ��,E•�`- MonthlySewerService ��'��- /�7CL.. � <br /> Unplatted Description Monthly Sewer Constr. <br /> Tru,ik � � r I <br /> TYPe Permit:_ -� %� i ,•- C-.�i: ;n �L� �'iC' «J f <br /> La;:era l i <br /> Remarks: � <br /> Abutting Lot Line <br /> - N S E W 7 C_ ; <br /> , fL � <br /> t <br /> APProved B�-- 1 lL.,1_: �_? � ,�_.L, � <br /> — __ Qty Engmeer � <br /> Issued By L- . ;\ C �- (� t_I���it.,_/ � <br /> ! <br /> Inspection By /(Y /,( �.�'+ctZ�r,� i <br /> � <br /> � <br /> -- -- Date l nspected���7� <br /> SEE SKETCFi �'�.TTACHED N0. i <br /> -„��.a- "�:. , <br /> ��, <br /> � <br /> - .,,t ': .• 1�1 n 1 ... . t �'.c,'l..a7{y � <br />