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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. � 1 � ,��'i DATE � /�..� 1%�% <br />CHART N0. �=% — � <br />1 <br />, . . � . L_� <br />�_ <br />:� � � .�j �j O C,//i4' f%v--- Utility Accoun[ No. `3 � " Y' " � � � � a <br />ServiceAddress � �7� �Q <br />� � � �D <br />Billin Address r �'�'—'—' ��`'"'�'''�� ��''�—Permit Fee <br />9 yo , �, ,�,_ . <br />�„�„ ���.uC /� - <br />r ,� r �f ifi B :�;?�a—Ft�—Connection Chargels) -1 ^ � F:' �..� ' � <br />City, State, Zip F— �� <br />Owner (Mortgagor) �7 f 7 j. � S/!LA'%oiM:i�N Total Fee �� Vu <br />Billing Name�r �11 � •9 L_� �/�,'1 f.� �: .: /" 'r <br />Connection By `-�� ��� L <br />Address �'� �� '" �� � Si <br />Phone.� � �� � � �yUll /� L�'/i� % ��JJ � <br />�7�'— 1S` / <br />DESCRIPTION: <br />Lot <br />= / Block ""'� <br />Plat � � l /Jt /= C'A /�' K <br />Unplatted l)escription <br />� <br />. .._�__:. <br />Sewer District <br />,� � ��_, �.,�1� <br />�,�- <br />Monthly Sewer Service <br />Monthly Sewer Cons:r. <br />\ SEESKETCH ATTACHED �� <br />., •L �_; <br />Trunk ''"' <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />� j <br />Approved By=— l ,_ � ; ; r ...� � <br />Ciry Enginccr <br />Issued By1 ^-' r � <br />Inspectian By �'�` �ZL'�"� <br />Date lnspected � �v <br />N0. � <br />ai <br />