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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer A,�plic:ation ar�d Perrn�t <br />N0. � !,.';,�� • DATE i � � . <br />Service Address_� =� - � `r � � i',� c _; . <br />BillingAddress ' `� G"� — ��U� �+j <br />i <br />CitY, S:ate, Zip L_ �, l-_.>: t. f.! .•r•, c'i.: Q- <br />Owner (I�ortgagor) � `` -- �• -� ; -,,i� . � <br />Billing Name it_ i,.._., C_-�. ; _ �_- <br />Connection Bv „" - . � <br />Address__� --:,�:.. <br />Phone—= '" �, _. - �. i , <br />DESCRIPTION <br />Lot t <br />i Plat -�- <br />Unplatted Descr <br />I Type Permit: ; <br />; Rernarks: <br />Block_ <br />i \ — <br />�_r.., �c.��,l�d_1LL� -i r : <br />,C1cG � �`� 2-//� 47Z-OU <br />I SEE Sk:ETCH ATTACHED <br />, t� ..SPi-CTI���I <br />� . _: ..,,_ . <br />� ;-._ _ .. ..t �_ :.�_ :.. . ... .. .: .. <br />, <br />CHART N0. - <br />. � ;if r. <br />Utility Account No. - ' �` _ � ` � � ' % <br />< ,_ <br />Fermit Fee_ -� <br />— -- <br />Connection Charge(s�_'- ��-' ti<<' (s%z, �� r <br />T <br />Total Fee - � ' <br />/- <br />Signed .c I ' ',;=�,�.� <br />cu;tom^r — <br />i <br />Sewer District �' i�C-.�_��� r� <br />�; �_�� <br />P/lonthly Se�.ver Service �- <br />Monthly Sewer Constr. <br />Trunk � ' ` <br />Lateral <br />Abutting Lot Line <br />M, S, E, W <br />ApprovedBy_'_ i_ r a..'�d.,;_� <br />Gry Engineer <br />Issued Bv _. ? r � ,., .'( i <br />i � <br />��-�,--- <br />InspectionBy li���,�Cl`Y � ��-.� <br />Date f nspected�y / 7 � _ <br />%— ' <br />N0. e� � �_ : �.�`' <br />,, ,�a <br />- _. ��} ..._' i ....n, . ..�_���y. ^ . �� <br />