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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART N0. �j� 3� • Z�1 ' y <br />N0. 2�896 DATE � J �_ L <br />Service Address_lJ`�o-3 i'G ��� fSLC,r- %�,rl�qity Account Na <br />/0 3 �'C�,.c, <br />� s�i3 <br />o� <br />Billing Address �% � ?�o___�_� f Permit Fee D <br />/±�./ o� <br />City, State, Zip� O � <br />� � ( �L/� Connection Charge(s) �s <br />Owner (Mortgagor) //�IGi� .YJSL����rotal <br />Billing Name �y.�.. <br />0 <br />30°� <br />Connection By_��'�f'� _ <br />Address � �� 7 ��.4� G � � <br />Signe� � � <br />Phone- .� �3 — [o Z— � � <br />DESCRIPT ON: <br />Lot� <br />Plat _�' � U <br />Unplatted Descriptio <br />Type Permit: <br />SEESKETCH ATTACHED <br />INSPF.CTIOIJ <br />cu:tomer <br />Sewer Dfstrict � y %�i�-n.s� �� <br />Monthly Sewer <br />�9onthly Sewer Constr. <br />Trunk //� <br />Lateral y SD <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />ny Engmeer <br />Issued By� /!�.(�/,y..� <br />Inspei <br />)ate I <br />rvo. 22896 <br />