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� <br /> � everett <br /> � e CH�RTNO.�=�u_ �-.- <br /> � Pa s ��: a <br /> � �itY of Everett ' <br /> I' s <br /> Engineering & Communit ��(� � � <br /> ! Y Services 1 <br /> I Sewer �4PAlication and Permit �� <br /> fVo. F 2�1. �i <br /> DATE �L-�/ 7�7c <br /> Service Address� � �';/ �L��,E <br /> Billing Address ��X �,��¢ Utility qccotmt No. <br /> � <br /> Cit �= � Permit Fee G• • �;._� <br /> Y, State. 2iP '� c-_ . r. ._. <br /> �— � � - `'L�� <br /> Owner (Mortgagor) Connection Charge(s) <br /> i � -- <br /> �'�t�'� Toial Fee L, � <br /> Billing Name �:=��,�,�L ---�' <br /> Connection gy � .�s��a�����. <br /> Address � <br /> � Phone �l.c- �_ �� Signed .�''�C.�,,,_.i J <br /> -- �Z� Cusmmer J/ '/�?'l G.��,`�- <br /> DESCRIpTION: <br /> Lot�� '�,�_ � Sewer District <br /> Block � � '� <br /> Plat�� [=Z=r-77' � / <br /> � ��" "� � Monthly Sewer Service <br /> Unplatted Descnption � {" � <br /> Monthly Sewer Constr. <br /> TYPe Permit: �'_�, <br /> � I��/i�.% � <br /> � Trunk <br /> Remarks: Lateral <br /> Abutting Lot Line <br /> N, S, E, W <br /> j ft. <br /> � <br /> fApproved By L . �-.l`� <br /> f City Engincer <br /> � <br /> ' issued gy l•��/� ,J/����, <br /> � <br /> � <br /> I <br /> � <br /> Inspection By <br /> I � '�c�_� <br /> I SEE SKETCH ATTqCHED Date Inspected � <br /> i <br /> � ;n!_;PCCII��;�� NO. � <br />