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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sew�r �►pplication ar�d Permit <br />NO. ;1' L;i l i� DATE ��z 7J� J l <br />'� A V rL <br />Sen�iceAddress ��3 '���`rlvrZ�r <br />Billing Address S� � ��— <br />City, State, Zip �` ��%�irz N�� �Z�'� <br />Owner (Mortgagor) � n„ k �o'= � i•� a <br />Billing N <br />� <br />Connection <br />G�,•�:., - <br />� DESCRIPTION: <br />Lot �"�r `'" Z`� Block <br />Plat i�t Y� '• I lhlce/� �S ��� r� �- <br />Unplatted Description <br />7ype Permit: SGc�(ri� �or+�����7� <br />Remarks: <br />SEE SKETCH ATTACHED <br />CHART N0. ����1'�- � <br />� <br />o,S ( c:' �. <br />! �� <br />Utility Account No. <br />Permit <br />�i"1"-)— L�"1—,x� <br />� ^ <br />Connection Charge�s)_ ��� <br />Total Fee 3� <br />: <br />Signed � .. .,.....; .,._1�: <br />Customer <br />� r� s; � i-c i ir�� ��i <br />Sewer District � � /� <br />Monthly Sewer Service Z• SU <br />Monthly Sewer Constr. <br />Trunk � � S <br />� <br />Lateral � Z� <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �� `' v ' " � � ��,� � <br />Cit EnB�neer <br />: 2. i ..� : �. � <br />Issued By l`� <br />�nspection By �", ^ " '" <br />Datelnspected (� � 7-��--- <br />N0. <br />