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CHARTNO.�fZ L' 9-^� ' <br /> everett ��, �'? . �Z -�8 , y i' <br /> �i {;�/� � � <br /> �s ; , <br /> City of Everett � �� _� ` , <br /> Engineering & Community Services � I <br /> i <br /> Sewer A�plication and Permit � <br /> , <br /> N0. L �C� �� J J DATE i/ � <br /> Service Address � ' i { <br /> _ Utility Account No._ / � � <br /> Billing Address_1 Permit Fee � �� ('�� I <br /> City, State, Zip ! Connection Charge(s)_ ��'« �� <br /> i <br /> _ � i <br /> Owner (Mortgagor) . Total Fee_ �� � <br /> Billi�g Name _ <br /> I <br /> Connection By � 1 <br /> Address Signed'/��(/�' `�--�- ' <br /> cu:tomer <br /> Phone <br /> DESCRIPTION: Sewer District_ �-^ �� L � <br /> Lot ' Block i <br /> Plat Monthly Sewer Service ' '� v ! <br /> I <br /> Unplatted Description Monthly Sewer Constr, i <br /> Type Permit: ' . Trunk %� = r j <br /> Lateral � <br /> � <br /> Remarks: ; <br /> Abutting Lot Line <br /> N, 5, E, W ft. ' <br /> � � <br /> i <br /> � <br /> i <br /> _�. � <br /> � <br /> Approved By ' <br /> Ciry Engineer � <br /> . � <br /> i <br /> — Issued By <br /> I <br /> _ � <br /> � <br /> Inspection By �� C � <br /> ' — Date Inspected / / ��, <br /> SEESKETCH ATTACHED NO. � <br /> ,�,:.r , . �_ .,,-- --�r;---..�,. i, ���>rcnon; �— � <br /> , �-�-�-.�-�-� � ' � <br /> , . u. � � � ��" � _ �'i_ ,a_ _;�,; "'` , <br />