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E CHART NO. <br /> cvcrt'tt /�� 5 � Grp <br /> i <br /> Z ' <br /> City of Everett <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> NO. DATE ._ /� G 77 <br /> 7� <br /> Service Address Utility Account No. <br /> -� oa <br /> Billing Address nt"iF� Permit Fee <br /> City,State, Zip o V1 ,1/ k m <br /> (JA . ��eC23 Connection Charge(s) 1�P L <br /> � '� <br /> Total Fee <br /> Owner (Mortgagor) <br /> Billing Name <br /> St' i�T ` <br /> 5n . <br /> Connection By <br /> � rr <br /> Address (I f z z SNS hf Signed__, Customer <br /> Phone--3-3(/ <br /> Sewer District <br /> DESCRIPTION: a �' �/ / f G <br /> Lot tot L � 4 � Block Monthly Sewer Service <br /> Plat L�a t/ / (o, r. `� rir; lJr /• <br /> Unplatted Description <br /> _Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: fico, ! �7 <br /> _ Lateral r o 4 <br /> Remarks: Abutting Lot Line <br /> N S E W_ it. <br /> i <br /> i <br /> I <br /> i <br /> Approved By ( v ✓ I f:ryh/Al L <br /> cityiEnginew <br /> Issued By � —s-- <br /> I <br /> Inspection <br /> Date Inspected— ���� <br /> ~ EE SKETCH ATTACHED NO. <br /> Iil.,� ; CI Inll <br />