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i <br /> CHART NO.�� � / "G� � � <br /> everett � <br /> �,-`� � <br /> ��/ �'�°-�:= _ <br /> City of Everett � "��f� � <br /> 1 <br /> Engineering & Community Services R <br /> _-- �-l-- i <br /> Sewer Appliaation and Permit � <br /> , � �NO. �' �� ( � .<l DATE ' � �7 .%; <br /> Service Address �� 'v �`�-=��" '' � --• =-�—_ Utility Account No. I <br /> � � <br /> .� � <br /> Billing Address � � � "'�`` � �'" Permit Fee_ -� U � <br /> City, State, Zip � ^ •_ ^�����'�'�� >y`� '�" �' � Connection Chargels) — <br /> 7 ; .� <br /> Owner (Mortgagor) '�+ ' "t ,�->� ��'�`'''��� ` ' Total Fee � U ' <br /> r' <br /> Billing Name "�'�- 'f^`-�' <br /> Connection 8y /' , :t '.. <br /> (. ''r,,< <br /> ` ; <br /> Address Signed %� w� ( "� • � �' "— <br /> `-' Customer <br /> Phone <br /> -i <br /> DESCRIPTION: Sewer District '-` � -' - <br /> Lot � � ' _' � Block � � �� <br /> -;. i Monthly,SewerServir_e <br /> Plat ,..� � ;,.r � .. f ,. ,, <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: % � ��*!�,r <br /> ^, . Lateral - <br /> Hcmarks: <br /> Abutting Lot Line <br /> n, S, E, W ft. <br /> _ � , j <br /> i <br /> ApprovedBy �-�•.- ,.�, � <br /> Ciry Enginee� „ � <br /> _F` b <br /> f �� Issued By ,`.�/• � ' "� -' <br /> � <br /> . � G���. � 1 <br /> Inspection By � <br /> _ Date Inspected b � C� - � �7 � <br /> 0 .�" <br /> SEE SKETCH A'fTACHED � N�• , � <br /> i i!'=�I l',�f I i`.^; � <br /> ..�n. 3 ' <br /> � <br />