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everett I CHART N0. � • �' �`7-5 � <br /> � , � I <br /> �� , ,- �: <br /> E�- �-- 7 �! <br /> � i <br /> City of Everett /�-k <br /> Engineering & Communiry Services ,� <br /> I � �e�nrer Application and Permit <br /> NO. , ' . ' , �! '; DA"I'E j �'' %?� i <br /> --- ' <br /> Service Address • ' � ' _ — <br /> Ulility Ar,count No. <br /> Billing Address Permit Fee I <br /> Ciry, State, Zip Connection Charge�sL <br /> Uwner (Mortgagor) Total Fee - - � <br /> Billing Name_ I <br /> '; �r- I <br /> Connection By �. c ' , � <br /> / ,,1' i , � <br /> Address / <br /> Signed� � __ •_ - <br /> Phone CUS�OTCf - ! <br /> — ------ <br /> — -- —----- � <br /> DESCRIPTION: � <br /> Sewer District <br /> Lot Block_____ — — � <br /> Plat Monthly Sewer Service � <br /> i <br /> Unplatted Description Monthly Sewer Constr. , <br /> I <br /> Type Permit: � � ,_ _ ' � Trunk { <br /> _ --- 1 <br /> .�,. � �— r`"" ' ; <br /> _.__ .� Lateral <br /> Remarks: ` — <br /> _ � <br /> _ I �.�� G �� �' > Abutting Lot Line i <br /> i�r�ur <br /> —� ��/�- <_ N S F W � <br /> l/' �l', oL ..1./�� � ///. �. � --- -------- f L � <br /> � <br /> i <br /> — . I <br /> Approved By ;' I <br /> CUY Engineer --�— ( <br /> �.. i <br /> ISSUBd By _'_ __� I <br /> �T � <br /> i <br /> -- __._ __ Inspection By_��!� ..._�_�y.� � <br /> o ----- ------- ----- Date Inspected_� � �U — 7 � <br /> i <br /> SEESKETCH ATTACHED <br /> i� ;Fi r NO. I <br /> � � �. � . . eae:v'. .. . � . , ...,.. �Y: � . � . ���'��5'��w . � ..�T ,r.. .:� � <br />