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everetl CNART N0. Tf �D "Z < " S � <br /> � . . � 1 <br /> A � ��� � S�� , � <br /> � ' <br /> City of Everett �� � 7/ .�� � <br /> 2 ��� � <br /> Engineering & Community $ervices � � <br /> Sewer Application and Permit �� ; <br /> i <br /> N0. < � /� �_`. is DATE � � � �� <br /> � <br /> Service Address.—1���:=•� Utility Account No. ' <br /> Billing Address Permit Fee " =--t--- <br /> i <br /> .�-..-�--��."� I <br /> City,State, Zip Connection Charge(s) <br /> i <br /> Owner (Mortgagor) Total Fee �� i <br /> � <br /> Billing Name � <br /> y� I <br /> ConnectionBy -' � -• ' �i <br /> - ; <br /> Address f'� -- Signed_ " '" � - - (� I <br /> �cu:mmer � <br /> Phone � <br /> I <br /> DESCRIPTION: Sewer District � <br /> i <br /> Lot Block I <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. � <br /> t <br /> Type Permit: ,..-, , - - _ � Trunk ; <br /> � Lateral � <br /> Remarks: <br /> ��� Abutting Lot Line � <br /> Ger�*Gr� �� N`� N, S, E. W ft. <br /> � � .1 3� ' <br /> � M , � v,,. /0 ; <br /> Approved By r' � i <br /> Gry Enpmeer • <br /> � <br /> N � , � i:s�ed ay '"' - 1 � <br /> c�' /Ui <br /> �....� ; <br /> -riM�! �dr' li'o 0 � . / ' i <br /> � I <br /> Inspection By �.--o--d-a <br /> �� <br /> ---- -- -- Date Inspected �/ — 7� <br /> SEE SKETCH ATTACHED N0. <br /> I:'�.-r: i...:n�: <br /> .. - i�'�. ,. <br />�.. _ _ i::_ . — . .._ _ _ _ <br />