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everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />S�wer Application anr� Permit <br />NO. �._' :-' .� U�i DATE y/b 7� <br />7 � <br />Service Address ! 60 7 :=f%=�rLE� -,.� ,'t-' <br />-� <br />Billing Address-� ��� �-�� �S %� <br />: � <br />.� / <br />City, State, Zip�'. �--rr.ir.rr•� ,.��c. '�FO 3S <br />� <br />', 7 �+ - <br />Owner (Mortgagdil f"' ��� .r.f:. - � (_r�. /�.c- . <br />r'� <br />Billing Name -�'ys�>-��_t.�� <br />Connection Dy �'��- -�.-�---- <br />Phone J��— �% �/�/� <br />DESCRIPTION: <br />Lot .3 Block 3�� <br />Plat._::.�• - �� _S.-"-y '%�� <br />Unplatted Description <br />Type PermiL �f�..,�,� <br />Ramarks: � ���.�,n��. <br />. �, ,. , - - - <br />SEFSKETCH ATTA�HED <br />� ` , . -� � j' � ,,� :t:. <br />�c,4`�.,r.d�r � i�`�`v ..1��` `i <br />CHART N0. � � <br />/`�• f r�� <br />�� �z � -- � � - <br />Utility Account No. <br />G�� <br />Permit Fee� <br />Connection Charge(s)_���_ <br />L' �� <br />Total <br />Signed <br />CFiE'C& AO. 283 <br />Sewer District. <br />MonthlySewerService �"--•-'� �� . <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line � f � / <br />N S E W_ lF'.,, ,. ,. ft. <br />--�'' j� ' <br />Approved By� � /FL = � -.-�-r <br />Ciry'cngineer� <br />�-n <br />Issued By_ � ' � ,r�"'�i- <br />r�,' • . <br />InspectionBy ��-=-C'� ��� ��„•�^' <br />Date lnspected `T�/ ��'� <br />N0. <br />;; �t . , . � �r`;i�. <br />` `d�.;^ ''�ta.`+" L?..: <br />