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�i <br /> � Y�I <br /> CHART NO. <br /> Ieverett <br /> e � <br /> City of Everett <br /> Sewer Application and Permit <br /> Pos��1 KB . :-i-e> <br /> No. 24461 <br /> DATE � 3 Ini i�_ ,- - - _ <br /> Service Address o� Utility Account No. <br /> �^ �' <br />' Billing Address__._�� / Permit Fee �� <br /> I City, State, Zip ���L �D� Connection Chargels)—� — <br /> Owner (Mortgagor) c�a�?ze��`{"�"otal Fee �D <br /> �/�� �i � � i <br /> Billing Name. <br /> / / � � �•i• _,.-l�--.._-�Zrs�--G.;;Fi <br /> Connection By� <br /> Signed Customer <br /> Address. ��U� �� <br /> 9��as'� <br /> Phone ✓�3�' � ��� � <br /> DESCRIPTION: Sewer District <br /> Lot ���— �� Block Monthly Sewer Service <br /> Plat � �_ '' � � , <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk _ <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutiing Lot Line <br /> I N S E W_ ft. <br /> I <br /> I <br /> Approved By�: " � <br /> ��V �8�^ccr <br /> Issued By��� <br /> Inspection o�"""��a""`� � <br /> Datelnspected � "'�" F� <br /> SEE SKETCH ATTACHED N�• ����� <br /> I_ INSPECTION <br />