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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 21J7� DATE _ ���'.�`""i-7 <br />1 <br />Service Address Z�''� �� �4 ��-���� Utility Account <br />BillingAddress 5��+�==- Permit <br />CHART N0. H� �'2q'.� � <br />i°m s ��o ,¢ <br />City,State,ZipC��1�+Z-L�T `=��>�� ConnectionCharge(s) i <br />Owner (Mortgagor�'�"� �� �- �--�`C�� Total Fee NUI�I� � <br />Billing Name �+-�+�� G �� <br />Connection ey- � � �`r p1�- �. �It:�= t_.r'�7 . ! <br />Address_ Signed ��-- TJP__-c_'�S�dz' y' i <br />Customer <br />DESCRIPTION: 4. S�werDistrict <br />Lot "��� "'•-' Z-- Block�'f U ��P""�"T' F <br />. ... _. <br />Plat �T l Gt ��;L��� N�onthly Sewer Service. <br />OCf q t9�i f <br />Unplatted Description_ Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPI C1ION <br />iutting Lot Line <br />N, S, E, W ft. <br />proved By � ' �� �� � h-%� <br />Ciry Engmeer <br />18d BY�`�--L/� /�.y11% <br />�ection By �-�-/ 3'-��l.lr-r� <br />e Inspected_ �6 - G1 ` 77 <br />