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� � CHART N � �" ��� <br /> everefl ��s, 7-� /' <br /> I e� /- z4 - � g <br /> � City of Everett �� <br /> Engineering & Community Services <br /> , Sewer Application and Permit :. <br /> � r�o. `�1�86 DATE I�`/C!l T 7 <br /> � , _ ��..,?-- 7G�- U/ <br /> Service Address ��C'� �`�---���� ��— Utility Account No. =� <br /> /, OU <br /> BillingAddress�` '`--GY_� ��L.� '� y�/ PermitFee `�"� <br /> yC�✓� � Connection Charge(s) �� �� % `u ��r. /(��� <br /> City, S.ate, Zip �%��Nc(..GYV7 � <br /> ` //�� O C) <br /> NOwner (Mortgagor���7 Z�� ��%V�T����r/G'�'�Total Fee `+'' � <br /> � Billing ''ame /-� ��'r���7�/l.C/GT/G��L' <br /> i <br /> Connection By ���'��� ���%v lIC 7/O.� � '� , <br /> r;.•1.7y, i . <br /> � Address �'���-�'C ; ��tt� � � _ Signed f•-f. ' .-�.�/ �.:a..Gr.-�� . <br /> Cusmmer \ _ <br /> Phone �`►'�1' ��d � _J <br /> � Sewer District ',' '�% /�,��/�-� ��� <br /> � DESCRIP-.T,I�ON: <br /> Lot�— Block /�� 7�JZf U <br /> � j ��0 � Monthiy Sewer Service � <br /> Plat IC- ��.w .-�G-�L� <br /> � Unplatted Description Monthly Sewer Constr. <br /> � 4 L' � <br /> / � Trunk <br /> Type Permit: �� � C.�C,'ti/,c/E.G7�U� <br /> Lateral L� . �>> <br /> ' Remarks• <br /> � Abutting L t Line <br /> N � W �ts <� ft. <br /> i <br /> i <br /> � <br /> t <br /> i APP,-oved By � �/t--N��'�-'T <br /> Ciry Engineer <br /> ' — Issued By � ��� GUiJ/I,.J�V <br /> ; <br /> � <br /> � Inspection By � � <br /> Date Inspacted �2 Z � <br /> 0 <br /> ' SEESKETCH ATTACHED NO <br /> � �(�SI'ECTII�r! • <br /> � � <br /> ' . . ..... . .�+.. . -�wasa <br />