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/I'f /+oa;.. „c.,!_C-79 <br />everett <br />e <br />City of Everett <br />Engi�eering & Community Services <br />Sewer ARplication and Per�mit <br />NO. �2J�J� DATE �J-�`�-lJ <br />CHART NO � �' � <br />�. 3 T�'/-J <br />G-�3- � a' <br />�,,,�' <br />. <br />Service Address �� �' � - � %-•� . Utility Account No. <br />� �_r� <br />Billing Address � • - - : c `�-' %! Permit Fee / �J <br />City, State, Zip ' � � " � % i'`, �:F/.c • �/! -� ;/5 Connection Chargels) <br />Owner (Mortgagor) <br />Si!ling <br />Connection <br />/ �/. <br />, .�._ <br />Address <br />Phone �-> ' � " � � ' � <br />DESCRIPTION: <br />Lot � BI <br />Plat'� � _ <br />Unplatted DescriFition__ <br />Tvne PermiL• ,�%� � � � . <br />� Total Fee j ��� ` <br />. ,t <br />J /' %^ '/ �� <br />Signed I'� r I/� 1'"/6i,_.,i: <br />J <br />" Cuswmcr <br />Remarks: <br />:?EE SKETCH ATTACHED <br />� INSI'CCTIO�! <br />� - <br />Sewer D <br />Monthly Sewer Service = J <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />_. � 7 <br />Approved By � •'' <br />Ciry Enginecr <br />Issued By� � � <br />i �. `�-T-- <br />Inspection By ��'�-1 �L"'"�-�—' _ <br />Date Inspected ��2� / % � _ <br />N0. ' :;'`: <br />`� <br />0 <br />