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• everett / ' -- _ <br /> �� ` r / ` _: v , M - - <br /> � � ; <br /> �� City of Everett <br /> Engineering Oepartment <br /> I <br /> � Sewer Application and Permit <br /> ! 33� �� � <br /> N0. 'Z�89�+. DATF � '"' / l <br /> / �W/ <br /> : Service Address�s��, �h/y/�,�D . _ - Utiliry Account No. —�'�"'---� <br /> Billing Address �A�`'�e Connection Permit Fee �,.Q � <br /> City,State, Zip__��f�r �/� Connection Fee <br /> Owner (Mortgagor�F/��L�G1/�'G��{/To,al Fce___.___�` ��__7_r____ ___ <br /> Billing Name �i�d�C <br /> Cannection By _ <br /> Address Siyned__ __ <br /> Cu:;amer <br /> Phone _ _—__ <br /> DESCRIPTION: Sc.ver District_____ <br /> Lot�i �� P�lcntlily Seri-er Service <br /> Block�_ ��,,� fI <br /> �ivision or ,4ddition_"�.7"�__.�,f F����___—�7onthly iewer Canstr, <br /> Type Permit: Trunk_ _ <br /> $�"f�1f�--���'`--- ---i <br /> � Lateral _ <br /> Remarks: �✓Ii%l�✓ N !�!l�� '�:-•' ^' ' <br /> �L r '�� ' ����� ��,� A�utti;;g Lot Line <br /> �' 1`0 U e !�e'�'!1" � f'�f S /�;'`:i,.°c�,*�"f'i�� N, S, E, lV_ ft. <br /> , .� <br /> �-��:(�; ���� /✓I./� r"/V h:,'`(cJ,-/'T i <br /> _ � <br /> i <br /> �Aopr�vad By___ <br /> C�.cy Enpinccr <br /> - j ' � . ' ___� <br /> _ ��sued �y— ----- — — <br /> � �_ ---- <br /> � <br /> �— --� <br /> _ —� � <br /> _ Ir.spection By� � I�-�*%' <br /> �--- <br /> i <br /> / �Date Inspected✓�U � / S — � S <br /> n ,, �.,� �� <br /> � � SEE SICETCH ATTACHEO r�o. 2 0 8 91 <br /> INSPcCTION <br /> 7 <br />