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everett <br />� <br />City of Everett <br />Engi�eering & ComTunity Services <br />Sewer Application and Permit <br />N0. �.C:��� DATE I � .: � 7 `c _ <br />Service Address l' � � =� '�'�� �- �'- � ����� �- <br />Billing Address �'y � ' �� =' �� 4' <br />City, State, Zip L-.��L. 11 C.- iT '' f L C; <br />CHART N0. �- S'G�R - <br />�I <br />s%`�� <br />� -2,� -�f' <br />��� <br />Utility Account No. =- ��/ r; �'7` L.�-, <br />7 �.��-' <br />Permit F�e —' <br />Connection Charge(s) = �`�"�' y � <br />� <br />Owner (Mortgagor) �-• � ��`�<< �✓<<'-]+�w �' "�����Total Fee_ ��'�' u <br />Billing fJame �--- 1<� i�� �, t-��c.� �� ut;; Lc.1-Tc.7 i� . <br />Connection By� _• IGi,� t� �`����UNt`, �C.IT'��TiZ �� ', <br />r. ' <br />Address � � �-� � � � `-�'Z� \ � • <br />i <br />S i gned t\ �� <br />cu: er � <br />Phnnn �G'..� z' �L. � 1 7 � <br />DESCRIPTION: <br />Lot ( Block i� � <br />Plat 1+�>t.r-��.� a_°�T `�t �.', �,. <br />Unplatted Descr <br />SEE SKETCH ATTACHED <br />Sewer District �C' �� �'-�� '-. , � �—� <br />Monthly Sewer Service �� � ��--'c-�- n <br />Monthly Sewer Constr. <br />l .1 l.c 'L�•�. Uu <br />Lateral 'L. �.�1 -:.Af�: `: I <br />Abutting Lot Li e <br />N, S, E,�' � 7 ft. <br />Approved By l- �"� E-�`-� �� �� t1 <br />Ciry Engineer <br />IssuedBv_ � ��`�--�A�a�aN <br />. / <br />Inspection B � C�t��/" <br />/�Q <br />Date Inspected 6 �" <br />N0. <br />-• ,._��i..__ � ` „�. �i, ... . . � 'i. � <br />.9r, ' >'� • . <br />