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' evereft CHART N0. � <br /> I � �`r��� <br /> � <br /> ' �m S �r`�J' � <br /> ! City of Everett I <br /> � Engineering & Community $ervices �a � �� � � ' <br /> � Sewer Application and Permit _ �'z '�'° <br /> � , <br /> ( NO. ,� �, , „ / / , <br /> � `- "- ` DATE ,./l ��'// `'. <br /> � <br /> � Service Address : 4 _i � �' (� <br /> � Utility Account No. � <br /> � BillingAddress_���)D % J;'.. � ' .' f '.�----� <br /> i Permit Fee <br /> ! CitY.State, Zip = rf . , % • � <br /> I ` " Connection Charge�s) <br /> Owner (Mortgagor�_ % _._ ';,l---"' <br /> � Total Fee • <br /> i <br /> � Billing Name <br /> Connection By �'- <br /> � - <br /> Address� '. ; _ ; _ 7 � —_ <br /> Signed <br /> Phone�� / . ;: � c���om,.� _ — — <br /> DESCRIPTION: <br /> Lot �_ ��- !/ _ glock_�_ Sewer Disirict <br /> Plat ' Monthly Sewer Service <br /> Unplatted Description <br /> Monthly Sewer Constr, <br /> TYpe Permit: , - Trunk <br /> ,/ - <br /> Remarks: Later: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � Approved By . � <br />� CIIV Engineer <br />� Issued 8y�_ �� <br /> I � <br /> Inspection By � � /a_� � , s �� <br /> I a Date I nspected 7�/O - �� <br /> SEE SKETCH q7'7'qCHED <br /> . � i,L ' i�-� �}iiii: NO. <br /> � <br />