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i <br /> CHART N0. � <br /> Ieveret4 I <br /> � 1 � <br /> po�-�� i, <br /> City of Everett � -o�--��i I � � <br /> 'cr�tion and Permit � � <br /> Sew�r A.ppli <br /> � , <br /> , , <br /> N0. 243�9 DATE �'' �� — <br /> � <br /> Service Address i � � � ' ' " ` ; — Utility Account No. i <br /> Billing Address <br /> ,-i .- (' / , ii . �- T ?ermit Fee— - �: ;� � , I <br /> City, State, Zip� :� r��iT ' �1,� :.`°'� r' Connection Chargelsl �� �� � <br /> ;i� <br /> Owner (Mortgayor) '_ -� �� � - Totat Fee_ f��� --- — ' <br /> i <br /> � Billing Name � l� L.._. 1�: c_. � , � <br /> Connection By �•J <� _ +� �_ _. _` -•-__- - - -- <br /> I ` .''� ;f- . I <br /> , �_ / f� : �" ��[.�C.. .� C . Signe� � � <br /> Addfe55' � Cuslomcr , <br /> Phone , . ,r <br /> _�-- � <br /> DESCRIPTION: <br /> Sewer District_ � � ' <br /> Lot Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description '� "�- � Monthly Sev�er Constr. <br /> Trunk <br /> Type Permit: ' ii. . *-= !' -' '�:'' Lateral - <br /> � i Remarks: Abutting Lot Line � <br /> 3, N, S, E, W_ it. <br /> � <br /> I <br /> �' � ,- �--/t_ a , . <br /> Approved By"' � — <br /> ' <br /> � Ciry Engince� <br /> � Issued By �� . --- ,__.r, � -, , .. ,..-i <br /> I <br />, � 7, � <br /> i <br />� I - Inspection By.� '-1<<�. �' i <br /> I Date I nspecte�.i__� �' -- <br />' I <br /> SEE SKCTCH ATTACHED N�• Z4..��� <br />, I ��f � � <br /> ird��eCi iuN <br /> I _ <br />� — _ —�-- — �= . --- <br />