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I <br />; everetl <br />I � <br />I <br />� City of Everett <br />Engineering & Community Services <br />�I�'/�':o�= !��',�-�7 <br />S►ewer Application and Permit <br />N0. t I_i)i %' DATE �" -�-�7 <br />CHART NOf,�' a���"�_ <br />�o�T�"� <br />2-C-� � <br />Service Address ��J � -_-c:�%�-�= = % � ''\' -- �-L- Utility Account fVo. <br />� ry-�- <br />Pilling Address _ � �0• �'✓ � � `' � Permit Fee _� U <br />, i �` � <br />City, Sta;e, Zip_'-f'� �`�r 1-`(.D .':"-' . '%� �%5� Connection Chargel <br />l <br />Owner (Mortgagor) :�-�`'r- •�� :,.�.a- �.�?c^t�� Total Fee 3 <br />Billiny Name - - - �---' <br />Connection <br />Add <br />��.�—/�3� <br />�ESCRIPTION: <br />I_ot •-� Biock _ <br />Plat _ ,� , ,�!' / ?.'j, <br />Unplatted Description . <br />Type Permit: <br />Remarks: <br />Firc <br />3.E. Corner 43rd snd Grand <br />SEE SI<ETCH ATTACH <br />i° <br />O '� <br />Signed V [� / j I (/\/ <br />a�:�om�, / <br />1 <br />Sewer District <br />Monthly Sewer Service ` ' ' U <br />_ Monthly Sewer Constr. <br />— Trunk <br />Lateral <br />Abutting Lot Line . <br />N, S, E, W,•'.�i :!�_...G ft. <br />I��i51'C_CiIUF�' <br />Approved By` ` �>�--, . <br />Ciry Engineer /' <br />L 'i <br />Issued By_- _ � <br />) �".• <br />Inspection By � - ✓ __ <br />Date Inspected_,i��7 a — <br />N0. <br />