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, . . . <br />� evereH <br />i <br />i � <br />I <br />i <br />' City of Everett <br />� Engi�eering & Community Services <br />Sewer Applitation cnd Permit <br />N0. c� ! `� �.� J DATE / - /- � <br />Service Address �^' �� �t� F 7 !�I G i� /_ ,�l.'l <br />Billing Address `�-� "' S "�i�� `-"' ' �C ' <br />i . <br />Citv. State, Zip -� � �� _ � , ,. , �, l�: �a _ �i.f %� 7U <br />�' <br />nwner (Mortgagor) � = �-- — <br />/, . <br />Billing Namet� �- .,•'ri �.- • -� ,.1 - � �;���c:r��� - <br />�_ <br />Connection Bv <br />Add <br />Phone � ` � y �� '� � 7 <br />DESCRIPTION: <br />Lot _ Block <br />Plat <br />Unplatted Description!�f %%J � 7lL" �t� ; <br />Type Permit: � <br />CHART N0. � � 7-�R`� <br />f•�a'} �'-'� �....�'� - <br />� <br />Utility Account N <br />Permit <br />Connection Charge� <br />Total Fee '� � <br />- �;y_ �;o <br />�^�' <br />]D <br />o� <br />� � ;> v <br />c`�- <br />� ` _� <br />�j;t�� � �1 �,/ ��_./.L� <br />Signed � I ' .i" / ���'"'�/�.r.w�> <br />( Cusmmer <br />�I <br />SEESKETCH ATTACHED <br />SewerDistrict �� f� �% <br />Monthly Sewer Service_ ^� ' ' U <br />Monthly Sewer Constr. <br />� <br />Trunk �' �� _ <br />Ab�iting Lot Line <br />N, S, E, W <br />__. — � <br />Approved By '-' ,l'�-+� i..;� -- :. .. <br />City Enginecr <br />i j <br />ISSued <br />Inspection By "` %��'"""z"`c."� <br />Datelnspected �l._r?��% <br />/ <br />NO. <br />