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I <br />�I <br />�I <br />� <br /> I everett CHART N0. =— � - �� <br />'i - <br />� � <br /> City of Everett <br /> Engineering $ Community Services <br /> Sewer Application and Perrnit <br /> N0. 2�5Z6 DATE ��_.l7 _I . <br /> � <br /> ----_ <br /> ServiceAddress ' ��" � -�• ` .�✓ <br /> Utility Account No. <br /> Billing Address ^ F ' '� / � ,� -�, <br /> Permit Fee ?- `� <br /> , 1—":' J <br /> City, State, Zip • ' i F-r-� �� ? '�� ! Connection Charge(s) <br /> Owner (Mortgagor) ��'� . ./ . ' •-f, .- . _, ,—*� <br /> ,��. ,� Total Fee c � <br /> Billing Name /• /,� _ . �i --' , <br /> Connection By <br /> Address . Signed <br /> PhO�B • Cuslomer . <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Plat_ Monthly Sewer Service <br /> Unplatted Description � � ,-�,...•'' - ' �, , <br /> .�ionthly Sewer Constr. <br /> 5," - .� :�r�l �r. ',� . <br /> TYpe Pr.rmit: Trunk <br /> i � <br /> — � J ` f'r Lateral <br /> Remarks: :� — -- <br /> Abutting Lot Line <br /> N� S� E- W— ft. <br /> � _ <br /> � <br /> , i <br /> i' <br /> _ Approved By_ : /�• , <br /> —_ Cily Enpmcer <br /> ,� ' . <br /> IssuedBy c__, ;:_r_�_ _ r- <br /> — Inspection By___ � <br /> p------ — ----- --------- -- Date Inspected . <br /> SEE SKETCH ATTACHED n �; ry 6 � <br /> INSPCCTION N�' `' � �� <br /> � <br /> _ � <br />