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. <br /> I � <br /> CHART '�O. � � �� �� I I <br /> everetl � � <br /> � 1����-� � � _ <br /> � �' � � <br /> i <br /> City of Everett � �� �� <br /> Engineering & Cammunity Serwces <br /> � <br /> I <br /> Sewer Application and Permit `� � � <br /> N0. F) r ,,. :� .'� DATE � I <- �� �"/ c� , <br /> Service Address �� � � � � t'-'" �-- ,• ' `- 4 �> Utility Account No. <br /> Billing Address �.� c! L_� �r �; � , F.-, � Permit Fee �C- . �-�C' <br /> City, State, Zip ��� �`"' " � � � � �- __ Connection Charge(s) ; <br /> � Owner (Mortgagor) � t-i ' � �� ` �� ��-�- . �_. Total Fee ��' � � <br /> I �illingName :-� ��,•,,<.. _ , <br /> Connection By=�""-��- <br /> � . l: l_� Signed — <br /> Address � � f ��' � r� � P-�� �' , . ..�--. ~�� <br /> �_ ( cusmmer <br /> ( Phone L` ' -� �. �• '� __ , <br /> DESCRIPTIUN: Sewer District � <br /> Lot � ' Block � <br /> Plat Monthly Sewer Service <br /> Unplatted Description r_/�� >�' ` (�i�� � _Monthly Sewer Constr. � <br /> i <br /> I <br /> Trunk � <br /> Type Permit: �� �f�� ti-� - <br /> Laterel <br /> Remarks: <br /> Abutting Lot Line ' <br /> — _ N, S, E, W it. � <br /> - �2-e.�-��� ' <br /> � APProved By � �/� ��J,(//iU� I <br /> cnv Enpinr� � <br /> — Issued By� . �/� �-/l/�rinJ i <br /> Inspection By �1�G'�u�'�'�"-�"" <br /> o _ Date lnspected_���� J � 7 � I <br /> 7 <br /> SEE SKETCH ATTACHED N0. i <br /> ir�� ��i ;� ii���� �� �� <br /> i <br /> r <br /> i <br /> i <br /> �----- - <br />