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evereti <br />� <br />City of Everett <br />Engineering & Community Services <br />Sew�r Applicatson and Permit <br />N0. - DATE (L"/' �' ��d <br />J <br />CNART N0. � —� ` L �':' <br />5/9 "��% S <br />�s ��� <br />z -Zz-�� <br />� <br />Service Address � l�� rJ '� ` 1� '�, '"" •� ('.'� Utility Account No. <br />% � 'v <br />Billing Address �� Permit Fee � <br />City, State, Zip <br />Owner (Mortgagor� � �' <br />Connection Charge(s) <br />/� �i " ; <br />Tota6Fee , ; <br />Billing Name _ <br />Connection By ` •-' -�`-r � - - -r i ` '— \ <br />, : , �(ti .y c�'' �� "�^t�,L., I �..�` <br />Address � Q • " �� ✓ /^ � � Signed <br />_ , F. _ �(� Cus�Omer <br />Plione <br />� 7 ��- �,- ;1� �— <br />DESCRIPTION: <br />Lot.._'j_ ; � 9�k/*,o //__ <br />Plat - � <br />Unp�atted Description <br />Sewer District_ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />m <br />SEE SKETCH ATTACHED <br />j' _y-. .Y.'l =.�F,�S� <br />•'; r: � f}. <br />Approved:By� /'�'- � <br />ChV Enginecr <br />Issued Bv ^ ' `�-� <br />Inspection By— !1�/'�'`�'/�� <br />Date Inspected '"� //��L%e`�7`-�-'"� <br />NO. <br />.._.,.--�-•--^�-.r,�7',p�? •_".�,�yr,�-�:�cnrr--� <br />