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_ � <br /> � f CHART N0. -^�r, � <br /> everett � , <br /> � - <br /> � <br /> �tosi:...1 ; <br /> 7�2�/7� � <br /> City of Everett " <br /> Engineering & Community Services I �r� i <br /> Se�w�r Applisation and Permit ' <br /> ;. � , <br /> N0. ', i ') DATE i��// --- <br /> —� � <br /> f � 1 <br /> Service Address_�-���J��_ -' .:%; �' Utility Arcount `Vo. <br /> Billing Address___ _ _ Permit Fee ' - — ' <br /> City, State, Zip ___ Connection Chargels) —�_ __,_,____ � � <br /> I <br /> Owrier (Murtgagor) Total Fee - � <br /> Billing Name_ <br /> , - i � ,::�' � <br /> Connection By�_�� <br /> Address— ,�� Signed � �-:�:�f � <br /> Cusromer <br /> Phone <br /> DESCRIPTION: Sewer District 1 <br /> Lot Black � <br /> Plat Monthly Sewer Service I <br /> Unplarted Description_ Monthly Sewer Constr. � � <br /> i i <br /> " Trunk I <br /> Type Permit: �;(r . -�� _. — <br /> Latera'__ _____ � <br /> Remarks: ,. n L�-�c[.c c •— � �� .j. ; <br /> ) 1 ' Abutling Lot Line � <br /> _�L�— �-L�. _��. � �:_�j.���._�_ N, S, E, W____ --- . —_it. <br /> 1�._��_�C�<< _- ; . ! <br /> - -- --� . ;,,::; ,. . - - - � , <br /> . <br /> �Approved By� . '�.�- <br /> . ._ _ � CiryEnpine�•r I <br /> Issued By _ _ <br /> �--�-- Inspeclion BY-- _ � i <br /> --- __ __ -- Date lnspected— -- <br /> p - - <br /> SEE SK:TCH ATl'ACHED Np, � <br /> . . :+c� <br /> 4 <br />