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� everen � CHARTNO.���' 29—,,5' <br /> � ` _�f J �^� : <br /> . <br /> J � <br /> �'— ,j -- � � , <br /> City of Everett -; l � <br /> Engineering & Community Services i ,,, �. <br /> $ f� ��- � . <br /> � , � ; <br /> ewer Application and Permit � ` - <br /> :, <br /> . � � � . � <br /> / � <br /> NO. : �O ';; t_' DATE I"`/��/% <br /> Service Address_ -v'� � ,y` � � = J. I <br /> " Utility Account No. <br /> Billing Address_ <br /> ----_ Permit Fee >.,.,-_. <br /> City, State, Zip / <br /> Connection Charge(s) � ��t <br /> Owner �Mortgagor) � � — <br /> Totai Fee !�"''-�'%':_-T_ -�� <br /> Billing Name � <br /> ;l �- v .,.�.,c. <br /> Connection By i', " �" �` . ` 1 ! <br /> `-----L— <br /> Address � � <br /> � Signed ^•� r�"'� r � + <br /> / '--•J� ! <br /> P�lOI1C . ' � Cusmm=r .� ; <br /> 1 �� � <br /> Df_SCRIPTION: � <br /> Lot �.J d /y Block .1 �� Sewer District_ �. ! " <br /> Plat_� , - �- 'rj"' ,�� . '� '� Monthly Sewer Service � <br /> Unplatted Description ! <br /> Monthiy Sewer Constr, <br /> TYpe Permit: � - Trunk <br /> —r._ .� <br /> Remarks: � <br /> I Lateral <br /> - P,butting Lot Line <br /> ' N' S' E' W TL <br /> " Approved By-_ i�r' <br /> . City Englncer � - <br /> 1 � � <br /> � _ IssuedBy�.:: . ;�y,��" <br /> --�— <br /> - � Inspection By_ ��'��� Y`� _. ,� <br /> a Date Inspected I _ � �� - `7� <br /> I SEE SKETCH ATTACHED R , � <br /> '' N 0. <br /> ''-'�'r'""';t.- if 'S!'i:CilOfJ <br /> I `�: <br />