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� <br /> i ' <br /> ;- . <br /> everett CHART ;JO.S 3�'-Z G—� i <br /> ' \ b � <br /> � � �o-� Tc_..�—r� i � <br /> /Z- ' G - '7 �� � <br /> City of Everett . � <br /> Engineering & Community Services I��'�'�'� � <br /> . I <br /> Sewer Application esnd F'ermiit ' <br /> � <br /> NO. �" , : _ ;i DATE ,�L` i '�• <br /> Service Address_ �i'/ :� t `.." C � <br /> � <br /> ---� Utility Account No. <br /> Billing Address _ Permit Fee__7- ��r--•�� ' -' � <br /> City, State, Zip Connection Charge(s) � <br /> , <br /> Owner (Mortgagor) Total Fee ,--�-�.�-��-�� , <br /> f3illing Name <br /> :b �+J ..r..r- � ' <br /> Connection By � .��� ��, � ;'� � � <br /> f� � i <br /> Address Signed�t�/ ��J ,= �.,,c-.,�-� <br /> -�r— , <br /> Phone c�:�o�� —' j <br /> DESCRIPTION: Sewer District � <br /> Lot Block <br /> Plat Monthly Sewer Service � <br /> Unplatted Description Monthly Sewer Constr. I <br /> Type Permit: �yo_ ,-;,� � Tiunk I <br /> ' Lateral ! <br /> Remarks: � <br /> Abutting Lot Line <br /> �Im :eei�eic �<.�f y �e { N, S E W ft I <br /> � <br /> .1.�f «. � �'fz �' <br /> i <br /> ; <br /> �l • <br /> APProved By`� '. _, ;;:-< ....: . <br /> City Engineer ' <br /> _� � <br /> Issued By �..r:'t--r,� i <br /> ��� I <br /> , �`� �� , <br /> /' � <br /> p o,1'a ,,. Inspection By��LI/ �1�iGi_ S cn-� I <br /> � <br /> ;.c, ' i <br /> o ,-.--- � Date Inspected //- �L�- 7.�' i <br /> � SEE SPtETCH ATTqCH�QI; �\�� � � <br /> _�� ; <br /> I � .. : . ' �` � .1�'�i,��P[r.•, Ic"' .- ,;�, ..: .. . . _ . ' i <br /> NO <br />