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' • � <br /> CH�.RT P1CJ.-_y �� - 1 � <br /> everett • <br /> e ;: - : <br /> ;... <br /> City of Everett <br /> (i . <br /> Engineering & Commimity Services <br /> Sewer Application and �ermit � <br /> N0. DATE i�/� � <br /> Service Address '% '=' '� � � 'Utility Account No.__ <br /> , � - <br /> BillingAddress_1-�'<J > � . , i=� [=�.--.,. ,. � PermitFee /�-� _ <br /> - .:.:'-(` <br /> City, State, Zip . %.,�-/!C�� . �✓,�i/ �� Connection Charge�s) <br /> ,� - y�- . � '�� <br /> Owner (Mortgagor��'�-, � ;'L �%'-/ Total Fee �G <br /> Billing Name- <br /> Connection By � <br /> Address '����� � � �=• <br /> Siancd <br /> - — �� ----�-�=-���i�,�,—,�,�_-_ ---- <br /> Phone -� .- � - �U✓% <br /> DESCRIPTION: Sa�vcr Distr�ct <br /> Lot%0 /`�-- /�81ock - .- -- - — <br /> Plat � -:;� y Monthly Sewer Service___�___ _____,_ <br /> Unplatted�DeS�riptTo�n ",`'''' Monthly Sewer Constr. <br /> Type Permit: ,.- ' '- Trunk __ __ ___ _ <br /> �� <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line � . <br /> ''- � N, S, E, W ;'� : <br /> �� �"�/T7 v✓ . ^ -- ft. <br /> 1 -- <br /> Approved By, -�/ <br /> _ City Enginucr ' <br /> Issued By " • - �'_.. <br /> �--f--- - <br /> - <br /> - i � <br /> Inspection By � �f/ � ✓„ot��/ <br /> /_ l �_ �,� <br /> — - <br /> o --- ----- - -_ -- - --- ---- Date Inspected�_ /�----- <br /> SEE SKETCH ATTACHED �:!ri <br /> y�`1��+� A�,aPF_: y,t JY'��Y} .t.��J:. _ <br />