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� <br /> ' everett CHART N0._/,rI'_�� ' , <br /> i . , _` � ;�3_i� , -- -- � <br /> � e ��� J <br /> � <br /> � . <br /> i City of Everett <br /> � Engineering & Community Services <br /> iSewer Application and Permit : <br /> �, ��, <br /> NO. [� ��, .'� 'i �% DATE �'� <br /> � Service Ad�!�t;; �('/ �:(i '_�� i- � _ 1'�tility Account No. <br /> � ! — <br /> Billiny Address � ��� Permit Fee �� . <br /> � City, State, 2ip__ ��:":� :%f•- / �/ � Connection Chargels) <br /> � Owner (Mortgagor) Total Fee__i " � <br /> � Billing Name _ ` <br /> Connection By �� , <br /> , . . � � � �. <br /> Address Signed '�:>.�l- " �����.. �� <br /> . __l� Customer — <br /> Phone ` % `"' <br /> —�l----— <br /> DESCRIPTION: Sewer District <br /> Lot . � Block <br /> ( Plat - Munthly Sewer Service__ __ <br /> MUnplatted Description Monthly Sewer Con;tr. <br /> � Type Permit: _ - Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W_ tt. <br /> ApProved 8y - <br /> _ C.ry Engineer <br /> Issued By - / <br /> I --�-- <br /> � <br /> I � <br /> i <br /> � Inspection By_ s":'Le�eJ <br /> - -- — - <br /> ------ - ----- - -- <br /> � � Date Inspected_� 7 <br /> , p - - - _ _ ��---- <br /> � SEE SKETCH ATTACHED ' N� <br /> � <br /> � / c �� i �� � ii� �� <br />