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� CHART NO.����' _ — <br /> everen �OSTL- O <br /> � e ��// <br /> ; � _ � _ , g <br /> � City of Everett ��✓�l�• <br /> � Engineering & Community Services <br /> , Sewer App�ication and Permit I <br /> � �I NO. , DATE �� � f - <br /> ,5 �, Z I 0 c� <br /> ServiceAddress ��`� l^�:/ %`� �J. UtilityAccountNo.i__ <br /> BillingAddress ��, '� 'G PermitFee _��7 <br /> � City, State, Zip � �� '�� /7 `'v/� ��z'� 3 Connection Chargels) y � � r�' ' ��1��� <br /> ,._ �,� � .., <br /> ( Owner (Mortgagorl �� ��U�� J.Y = Total Fee_.-.--- ---_t�'1?� <br /> Billing Name i �� ' '�'� <br /> ( Connection By � II�J''�N ;— l�.G "i. � -- 1 �-- <br /> Address���`/4 /��/l�.,�.� iGC.C� l�% Signed ^ / ` <br /> u ` ��J � , --� <br /> � --- customer <br /> Phone �`� .� ' � ' "!_. Z <br /> I ��--------- <br /> DESCRIPTION: Sewer District <br /> ( Lot Block — Monthly Sewer Service 1 i v <br /> Plat <br /> � UnplattedDescription ��'�r �- ��f.�Z- MonthlySewerConstr. <br /> I Trunk � L�� <br /> Type Permit: ( ' U�i�/v� �i�r•% �l <br /> I Lateral <br /> I Remarks: <br /> Abutting Lot Line <br /> I N, S. E, ��_-- -___ _ -- _ (t. <br /> I <br /> I <br /> i <br /> �� ApprovedBY ��` "��� / - . <br /> City EnBincrr <br /> � " � <br /> I <br /> �55�edev �i%�_,; !='=�— _ <br /> i <br /> I � � <br /> I ---- ---- - Inspection By� /'�-'„ -."�`n�"'--- . _._ <br /> � ------ — _ <br /> Datelnspected �� �� 7�— - <br /> I Y — <br /> � � SEE SKETCH ATTACHEB�� N0. <br /> � � <br /> � ::x"` ... _ , . ,. . . _ .. <br />