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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. L�,� l y DATE �"=" J'� <br />Service Address �-^ C' � ��� ��� - - �-- <br />BillingAddress �=`���- -1''� �-3 <br />CitY.State,Zip� t: .y ,y�• /�i,;i0�i <br />Owner (Mortgagor) ��-�-' �.%�-'-i��'�`1 <br />Billing Name � ��-->+�-� <br />Connection <br />�,_. . ,..� <br />`.+ S � ' `;� ,� � <br />DESCRIPTION: <br />�ot - y r <br />Plat �'- � - � <br />Unplatted Descriptioi <br />Block �GG <br />CHART N0.ly .� ' i- � <br />�a. <br />QS' i E-� - <br />Utility Account No._3 <br />Permit Fee ZO � <br />Connection Charge{s) ��— <br />� °� <br />Total Fee G <br />i � <br />_ Signedi. t;./' u�.u�^ v ��G ! <br />cu:mrtrer <br />tl <br />SEESKETCH ATTACHED <br />, .��.��rr,�,�� <br />Sewer District <br />-- /MonthlySewerService �""�%�i l�-_.�. <br />Monthly Sewei Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />� /� � _� J ' <br />T % <br />Approved By ?' / .�,:.>:.��.�. ,... <br />Ciry Engmeer � <br />; <br />ISSU@d By ^ . ( �'-• <br />Inspection By � ���^-J <br />Date Inspected // z� /� <br />NO. <br />. . y <br />�T.r � <br />1+kW�"+ek,..tt �k.i}�,.:.r� �r�;.,'. . <br />