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1 <br /> CHART NO. � <br /> everett <br /> e . =Y��_ = <br /> . <br /> . �� : <br /> City of Everett ` - <br /> Engineoring & Community Services . <br /> Sewer Application and Pec�mit � <br /> N0. ZZ9E6 DATE 1"" �� " 7 � — <br /> Service Address =� 7•=' 7 %�v;:. (i�;'r=:r,i t.,a�}� Utility Account No. <br /> �,. � ,v' <br /> BillingAddress 3 Z /4 �� P�C S '^/ Permit Fee � � <br /> City,State, Zip /� t�'�.+':-" f' t<.iU ��"L�3 Connection Chargels) <br /> . ,� <br /> Owner (h7ortgagor)�'+�� "� � 1'����y' ��� Total Fee Z ` <br /> BillingName __'��%'+'r�� <br /> � �.•f..r.�, • <br /> Connection By _ – � r <br /> 1 /, <br /> Address Signed /'?` �„�( : ��,Y�����< t• -�.� f� <br /> Cusrortier <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot % ' '� � Z Block �� <br /> Plat�<�=i= =T �f��= %� MonthlySewerService <br /> Unplatted Description Monthly Sewer Constr. <br /> I Trunk <br /> I Type Permit: - - <br /> .�i ��i�/i:.: (' �. .;,:.� Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> ,, <br /> s-' j/ <br /> Approved By a+.� •. -r�--' <br /> City Enyineer <br /> �`' . �l <br /> Issued By r� • , / .+r�;'�'^ � <br /> Inspecfion Dy <br /> _ Date Inspected <br /> a <br /> SEE SKETCH ATTACHED NO. �1�6 6 <br /> iNSPECTION <br />