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everett � � � � � �y� � �� <br />� �Tc � `�' 1978 <br />City of Everett ?.., ............... ..... _...,....,................., <br />�,1TY OF E'dERETT <br />Engineering & Community Service#'ublic \Yo:ks Or,pt. <br />Sewer Application and Permit <br />N0. ��u:�J DATE /�/�'/�"7� <br />CHART NO. �' / <br />1'os �'�r� - <br />/1-27-7-� <br />/ t /J./� � <br />Service Address �� �� �� 7�'� r�% -� �`� Utility Account No. <br />�' ,E ,:� _ <br />Billing Address �� �-'`�- � J 1 Permit Fee ��' . <br />/ . �- .% <br />City, State, Zip �'�`?�-•-�-��f �-" {2_��-:.< �` i 7J Connection Charge(s) �'�' ~ <br />Owner(Mortgagor� ���-�'"�✓:y ��' -F'-/�� �� TotalFee • 3� �'� <br />t--�— � � � <br />BillingName -}�-•'''�'-1 � J� <br />Connection By . �',' �� ,' ` _ ' / , r' <br />Phone � � 3' U 2 7- `1 <br />DESCRIPTION: <br />Lot � Block <br />Plat--'''��� -r1 _�':+.-,._,t� .i�Z�. <br />Unplatted D iescr ption <br />Type Permit: <br />; � / �.\ , <br />Signed � ' �' ' � <br />Customer <br />SEESKETCH ATTACHED <br />INSP�CrlO(�� <br />1 <br />�' I <br />Sewer District � -d ">�•s' i <br />Monthly Sewer Service 'L i�% <br />Monthty Sewer Constr. <br />�,• <br />�. . l-� <br />,� <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />:, <br />..> > <br />Approved By �%'- , .� <br />City Enginee� <br />/ <br />D <br />Issued By �- r �- �-u-. " <br />Inspection B C -1 <br />Datelnspected�� r� ��7 <br />NO. � �� . ;� <br />