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. <br /> . � �CHART NO.�'�$++-� <br /> � everett �0 5 '�'/,�'' <br /> , � .. <br /> � �— �i�" � � f"J i <br /> ICity of Everett ��`��i-'• • <br /> IEngineering & Co�:imunity Services <br /> j Sev�r�r Applicati�on and Permit . <br /> � �; �> (l i,l � DATE .�G�_ 'r� . /� <br /> � NO. - - <br /> ,/ � �.....,� - .>✓ �%'-; � Utility Account No. <br /> � Service Address � �� - <br /> { � , -,, `'"�' <br />, ! f>(�• � :+i ;C � %!� `l Permit Fee �-%'J <br /> Billing Address <br /> f `"'_ <br /> � City, State, Zip `~r�;��' ����"` v3 Connection Charge(s) <br /> � _ , ,, ",�. <br /> � y,� �, Total Fee -��� <br /> � Owner (Mortgagor) ---��� <br /> !%_. j . '-; .� • <br /> � Billing Name — " <br /> ' Connection By -""`� <br /> �� <br /> � Address Signed " � c�:io � � <br /> � <br /> I _.7L^� - 6� .:UU <br /> � Phone <br /> f Sewer District ��� � �'�"�' <br /> I DESCRIPTION: ---^ <br /> Lot_� -• � Block_—� , MonthlySewerService � <br /> � Plat_.. � <br /> i Monthly Sewer Constr. <br /> Unplatted Descridtion <br /> � Trunk � � '� v <br /> i Type Permit: Lateral r' y, <br /> ( Remarks: Abutting Lot 4i le <br /> ..: U �:� <br /> i N, S,`�,:W ft. <br /> � <br /> i — <br /> i • <br /> � . , <br /> � <br /> I APProved By �. � `�•' " <br /> City Engineer <br /> I <br /> I <br /> ' Issued By - ' ' %' <br /> � <br /> f !nspection By ��2'�-""""u� <br /> Date Inspected ���Y�77---- <br /> j � ,.. ,,. ,�. , — � . <br /> � SEESKETCH ATTACHED N�' � � <br /> � INSPECTION � <br /> �`^�. � <br /> - <br /> :� <br /> . . . . � _ ', ,�+:�:,r .�$���.�3���a..:; <br /> . ,t e. <br /> J <br /> � <br /> � <br />