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i <br /> � � <br /> I everetl CHART NO.� �--.7A'-_T <br /> � � �a5 l G�� l' <br /> � City of Everett <br /> IEngineering & Community Services <br /> � Sewer Application and Permit <br /> I <br /> NO. ; ,� 9 71 DATE - /� " �/ <br /> Service Address � ��' % r L,- • � Utility Account No. <br /> Billing Address � � ��� � / �l/%'� Permit Fee '� �I' <br /> City, State, 2ip^'- !� •'�%:- %� : � Connection Chargels) ""�J <br /> -. � <br /> Owner (Mortgagor) � r� - - r r'� _+ � / � Total Fee �U <br /> BillingName _.- -� �: _ �1 <br /> ! <br /> Connection By—_ -�:- ✓' . . �- <br /> Address Signed ':� .__../ �-<<..-.-.- <br /> customer <br /> Phone- S =- 3 - /j�J .; <br /> DESCRIPTION: Sewer District Y� I � <br /> Lot �'� Block <br /> Plat ' ' � � � /, - i, '. � Manthly Sewer Service Y 1 <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit ,,%,• , ' Trunk l� = �' <br /> c: . i <br /> Lateral /iJ <br /> Remarks: <br /> Abutting Lot Linp,.� , � <br /> _ N, S, E,NY- �' ft. <br /> Approved By ' '� <br /> Ciry Enpineer . <br /> Issued By-:'-- � <br /> I <br /> Inspection By��_�� � <br /> _-__ c_- __ Date I nspected___qf�_�___ <br /> � � �� <br /> � SEE SKETCH ATTACHED NO. <br /> i ii� <br />