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.� <br /> �."'�� <br /> � CHART N0. �' � �— <br /> Ceverett� � 'I <br /> 4 ,�.��s-;�� = <br /> � � <br /> M' City of Everett �G� <br /> Engineering & Community Services <br /> � Sewer Application and Permit <br /> � <br /> I, rvo. 2 21 � 5 DATE � 74 /y�{ <br /> { _ �. - - <br /> � Service Address �� ' � ,;,.f:... ' '� � �-''% Utility Account No. � ��.,� �/ <br /> � <br /> � Billing Address ' '' ^������ -�� ��� Permit Fee �' <br /> uv <br /> I <br /> City, State, Zip '', i � - ,�'7l'�L—�L.��/� yL Connection Charge(sl �.v T� �� 6> - <br /> / " ✓ <br /> ' Owner (Mortgagor) �' � ,• � � � , Total Fee_7 f� � <br /> � Billing Name _ _ �--� <br /> Connection By - <br /> Signed / i;i; ; ( ; r , ,,; t:� .. <br /> Address Custamer <br /> ' Phone y S ' ''' � �' �� <br /> � <br /> DESCRIPTION: Sewer District_ � � �—��.—� <br /> Lot Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description_??��1�./ ; _. � -"� Monthly Sewer Constr. <br /> - � _' Trunk_T <�!_li. <br /> i TYPe PerJnit: _{,... � � -_ <br /> � Lateral /%. =!�/ <br /> � Remarks: Abutting Lot Line <br /> � N, S, E, W C� ? CZ ft. <br /> f <br /> i <br /> ��✓�� I�� _ <br /> . Approved By� ' <br /> � Cif�gineM <br /> � /� <br /> Issued By — - Y _ , <br /> Inspection By ��C�%�"`'�"' <br /> Datelnspected / �� �7 � <br /> � a <br /> SEE SKETCH ATTACHED NO. �� c_ .'. �� �' <br /> INSPECTION <br /> � <br />