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i <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />14 <br />CHART N0. 1: .3 .j- <br />A.- <br />NO. 2.181 DATE <br />370 ,t= Service Address Utility Account No. <br />Permit Fee <br />Billing Address <br />lConnection Charge(s) <br />City, State, Zip s--f �'-{�/ `'�y O <br />//G� <br />Owner (Mortgagor)__� <br />Q�,_rL— otal Fee / <br />Billing Name i� /'DOS At IJl R SaN <br />Connection By <br />Address 22 <br />Phone_ ' ' r - y 5? 3 <br />DESCRIPTION: <br />Lot Block <br />Plat- 11A4 AV' ZAA0 fir. /=7. <br />Unplatted Description <br />Signed Gusto r <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Type Permit: C `+ H /-74 r y Lateral <br />Remarks: Abutting Lot Line ft. <br />N,S,E,W. <br />Approved By_/ A" <br />~�- <br />City Engineer <br />Issued <br />Inspection ey Z <br />Date Inspected 6 <br />c� SEE SKETCH ATTACHED <br />