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��Y�V <br /> everett CHART NO � • _ ' +� <br /> � �a S � �� <br /> � City of Everett �` � � � <br /> Enginearing & Cor.imunity Services /��� <br /> • <br /> �e���' p��plication and Permit � <br /> N0. � � .� O O DATE - , , f � <br /> Service Address Utility Acwunt No. <br /> Billing Address ' ' : - ---- 't Permit Fee <br /> City, State, 7_ip`� _ ^' ;�� . � Connection Charge(sl "�"� <br /> � Owner (Mortgagor) � "� <br /> : �� Total Fee <br /> Billing Name �� <br /> 1. <br /> Connection By r ,-"`; __ � <br /> � <br /> � Address � � �t�- ' ���� <br /> � Signed '�- . `�.' <br /> Cuctomer <br /> , Phone <br /> � DESCRIPTION: Sewer District " <br /> Lot Block " <br /> Plat � � � Monthly Sewer Service " <br /> i Unplatted Description Monthly Ce�„er Constr. <br /> � <br /> Type Permit: Trunk <br /> ' Lateral <br /> Remarks: <br /> Abutting �_ot Line <br /> N, S, E, W ft. <br /> � <br /> ' Approved By °�l� �� �[� <br /> . City EnBinecr 7���— <br /> �% <br /> R;.' " <br /> Issued By � <br /> � <br /> � _ Inspection By_ �/.�/./%(%—.,� <br /> � o Date nspected S /��l �7 c�' <br /> SEE SKETCH ATTACHEO Q <br /> � �--. Ifd>PECTION �y <br /> .._..' .,,. .n�H � .". _ I..�, �r`� ,.. �:�. . . .. <br />� <br /> � <br /> . .� %"�`�� ..� `Sr� � �� � ' n t .. <br /> � r. - . <br /> 4., '� n.�t"W1d+R�.} e bfu3� �� q� �� <br /> _ .. ' ' ' x � �s,�,4�n� �Ea }i�k ,. U — <br /> � �yry ,g3x4 i�'Y �`� e� 9 : . i <br />� .Wsa.d�,+� sbri4 >L . <br />