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CHART NO.��^= � s <br /> everen �--C�Y� <br /> �m4 , <br /> e � !8 ` �' "' '� �� <br /> � � <br /> City oi Everett � � 1 <br /> Engineering & Community Services �� � � <br /> Sewer Application and Permit � ! <br /> , <br /> NO. �' �, I : � � DATE � ' ' <br /> Service Address �o �� �,�'�—'' �-'—�/ Utility Account No. <br /> Billing Address Permit Fee -"3'-- • ` -, r <br /> City, Strite, Zip _ Connection Charge�s) <br /> � fjWner (Mortgagor) � '��"� y � ' �� Total Fee " •-�=-- / <br /> Billing Neme <br /> Connection BY_�� t '� � �:.,6� �••� <br /> / !/ y ' <br /> Address � Signed <br /> •: / �i-, '-.1'"!i ,' /, <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District — <br /> Lot�� Block� Monthly Sewer Service � <br /> Plat �-' i .��� � _�. L� � <br /> Unplatted Description Monthly Sewer Constr, <br /> Trunk <br /> Type Permit: �v <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> � 1- � S� N, g, E, W ft. <br /> i � <br /> — — Approved By� -,� �/ • - <br /> Cny npineer <br /> �/ <br /> - - Issued By r - '. <br /> Inspectian By � � ���-�� <br /> _ __ _ Date I nspected � — � "' Y� <br /> a <br /> SEE SKETCH ATTACHED N�• <br /> �� � � � � , <br /> � � . <br /> � <br />