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! h <br />��� v <br />r <br />r <br />ti., t <br />' 'n:�-'�n.�.�a,ri4"'�.+.,'+a^.+. <br />everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO. �� ���`3`"�� �' <br />r � <br />/'o � �-G,�',� _ '� <br />� — �. � = � � �I <br />i'v�� <br />N0. �2�.��� �ATE r`— ���7➢ I <br />%/� S �'�Gj' � �GcJID t,�� <br />� " =r �� . S•4� � Utility Account No. <br />��% /3�- �ti U ��� <br />Service Address_�T� , „�v <br />S `'' Permit Fee <br />Billing Address '/ <br />�.1� i � �.-�.-:i._ 2<-� <br />�" ���. ��,� _ �'� r Connection Charge(s)� —'- <br />� � ,. <br />City, State, Zip F, � �j� <br />(// %/�//�(J� Total Fee U <br />/l^Il(!N'•JI .iaf^I �'i4� (�l:�L_ <br />Owner (Mortgagor) � 1 . <br />1,`/ '%/ � . <br />/�7 1 l FL�)o�-0 i _ /'• •<..r : <br />Biiling Namef <br />;, <br />�� <br />Connection By ' l-''"�'"" - �"'� � <br />� Q r� c�-.r,.__�.._ � <br />Signed c„s�om�. <br />� , yy7'-� - <br />Phone > > � <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted CescriF <br />_-. . _ � <br />Block <br />,. � <br />; �Sewer District 36 "'�. ' <br />�- %/� /' I <br />..=j, �'-�,� .: <br />Monthly Sewer Service -- , <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />. _ t-- <br />..�-ix-�' �.�_<` } <br />. V^b"w.._ : . t ' <br />INSPECTION <br />Trunk � ''�' � �'�. <br />Lateral � � ' y6 <br />abutting Lot Line �� J �G <br />N, 5, E, W—�— <br />'"'��r�'� � /�,_ _ <br />Approved By r <br />Ci[y Engineer . � <br />• i'. <br />� � � <br />Issued By �' � " <br />r <br />Inspection By�� ��� <br />Datelnspected ��I�O/�a <br />�,: - <br />N0. '_- - ' <br />