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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. ? 1 (91 DATE C.aI ?� 117 <br />CHART NO./r(_—��_c� <br />/057c A CJ <br />Service Address �' 11t f Utility Account No. <br />Billing Address - <br />K—`I 1 ( [ )Z PerrT,.t Fee__ <br />City, State, ZipC' -&onnection Charge( <br />Owner (Mortgagor}->Lir VL•° �f=� 1'FtF:r (" Total Fee <br />Billing NameIzz--'A S ie[ E—`+ <br />Connection By 1� I r <br />Address( .-V I C. L <br />Phone t (-( (— L=LI (- <br />DESCRIPTION: <br />LoO'' LA Block � = <br />Plat L—t'-EOF L--)-r <br />Unplatted Description _ <br />Tvne Permit: <br />Remarks: <br />t = C. <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sower Service_ <br />Monthly Sewer Constr. <br />Trunk _ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W__ <br />Approved By I �r_a.? LJ r ,L j <br />City Engineer Issued By. (J/ C"., L. L- A 44:31P <br />Inspection By 'A <br />Date Inspected— 17 f �17' <br />NO. <br />