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. ._ �- -_� - d r ' <br /> CHART N0. �� ! �` " -� ' <br /> everett <br /> `i <br /> � �°s � <br /> City of Everett � " • _' � � <br /> Engineering & Community Services ' <br /> Sewer Application and Permit �� <br /> .� <br /> � . <br /> N0. � ? j � 8 DATE %!, �% ' ' <br /> Service Address_ /��✓ �' i'.�-%-" " �- ��9 Utility Account No. <br /> , �V � <br /> BillingAddress �C �� -at�.�...c�''� PermitFee ' .- -.' � , .1. Y ' . <br /> City, State, Zip � w��`�-�+� .�'+-��`'--�� % ` ''��� Connection Charge(s) <br /> � � <br /> Owner (Mortgagor) Total Fee y� � <br /> Billing Name ,' <br /> � � � <br /> Connection By - � �' ' '�/��.<.�! •� <br /> �. . . . ; : � � <br /> Address :�,c YG� �r' - ���;. .t^�z.�u'.�.. %i. Signed +. / `-"'F: l_,,_—, -� <br /> _ �- <br /> '�.. I � rpi� Jo . cusromer . <br /> Phone . -• '- '/- o�/f <br /> DESCRIPTION: Sewer District_ ' <br /> Lot_i % c- Block '"'�% � <br /> Plat -' � � � Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> . ,< � <br /> ,.. / ..,.- . "= %..; '.. ,,,� Lateral <br /> � Remarks: <br /> Abutting Lot Line <br /> N, S, E, W__ ft. <br /> � <br /> � � <br /> i <br /> APProved By .; � '. L'�•.., , <br /> —. - City Enpinaer <br /> 7 q�A <br /> Issued By � �<';=ti�"' <br /> Inspection BJ�/!G�iI.LJ/// C � <br /> n — <br /> Date inspected_L/ a/ �/�_ <br /> SEE SKETCH ATTACHED � " " '-� � <br /> NO. . . _ . „ <br /> � INSPECTIGPd ! <br /> �� , <br /> _ _ .. ._ _ . ,. , .,, . ,� _x ,.•, ,. .,ti., • i <br />� � <br />