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; everett I CHAHT NO.�:_/rZ �_�� _;� __ <br /> � I �6S/�-C�'J <br /> ! 9 a �- 75� <br /> City of Everett <br /> Engineering & Community Servir.es <br /> ; Sewer Application and Perm' � /�� <br /> � <br /> �t <br /> � <br /> NO. , i DATE � . <br /> — �, <br /> Service Address i ` , ; __� � ' �i 1) Utility Accouni No._,� - �L - � 'E-J / <br /> Billing Address__. ' � ✓ „ ( i i �1 /= - , -�� <br /> /� Permit Fec > - <br /> —`—— <br /> � CitY, State, Zip � r "," r .t , , ._1 �!' r �- <br /> Connection Charge(sl_ <br /> i <br /> � Owner (Mortgagorl� i " -i ^ ' • / Tot<.I Fee .J � � <br /> ----- -----__ <br /> � Billing Name 4 ' � r <br /> IConnection By •� :� i" <br /> � --- <br /> � Address �; , I <br /> � <br /> I --- — - - <br /> Phone----,----��— _ <br /> c��.���;;�;:,------- — <br /> i <br /> I D tSCRIPTION: Sewer District__.LF,_____�_��__ <br /> j .�• Block <br /> . - <br /> I Plat ,: . .. ` ,- Monthly Sewer Service ;_ <br /> _ . <br /> i Unplatted Descripti�n_ _ Mon[hly Sewer Constr. <br /> i -- <br /> Type Permit Trunk -� <br /> � ` � ,.., � — <br /> i Lateral -- <br /> � __ �'-`-- _ . _---- <br /> � Remarks: <br /> � Abuttiny Loi,Linc <br /> � � -- � N� 5�� �=� W ' It. <br /> .���ZL'�:C' %�zJ i� �iE�7✓ /N.`i 'T/�c [-b ) � ' - <br /> i <br /> _ ,��rr �r�, --=��� �x=�_u � <br /> �,i,n��,���d E;y <br /> — - _ _ ... <br /> — ���� � ,�" . <br /> /N��[� >> , � <br /> Issued By_ _- � ---- <br /> �1N l/✓r,i�ati'r - �C-: ' : <br /> /T � j � ----- <br /> - Inspection By __. __ <br /> � — -- - <br /> � , - - <br /> � �� /�a r ' � i./_'�� c.'. - - f. '�� ' � `, D,rte lnspec•ed _ . <br /> / - <br /> SEE SKFTCH ATTACHED %�c�/'< NO. <br /> � <br /> G��� ,... '.�� r n ,,�'�,�„'-' ,��'i.. �. �.,'�� <br /> � /. . . . . V! . . . <br />