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i <br /> everett cHART rvo.S' : � 3 ^Q , <br /> p � <br /> / � S�L= � <br /> e . _ <br /> �_ Zo _ � � :�� <br /> City of Everett <br /> r..,. <br /> Engineering & Community Services ����� � <br /> . <br /> Sewer Application and Permit ` <br /> � . <br /> N0. [' c� (� �„' tj DAiE �/�j,�fj <br /> Service Address— tr��� , Utility Account No. %% i: � ' '1 , <br /> Billing Address �:-' % � - °%'. f . , -• �i .:i .Permit Fee �' `" �� <br /> � - q -- <br /> City, State, Zip_: : �' '.'-" " j Connection Charge(sl �"' � <br /> .:—�- <br /> Owner (Mortgagor) ' � Total Fee -��� <br /> Billing Name �_._- <br /> Connection By _ � <br /> Address Signed - ; <br /> Custnmer <br /> Phone_ ��/j` :� j � �� <br /> - � <br /> DESCRIPTION: Sewer District <br /> Lot � Black „� ! <br /> Plat � Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr, <br /> Type Permit: -- �, Trunk �� • = U i <br /> Lateral <br /> i <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. '� <br /> � <br /> I , <br /> Approved By �� > <br /> � Ciry Enginccr , . � <br /> i � <br /> f - - � <br /> Issued By �� <br /> � <br /> Inspection By_ ��...G �s-.�c.-c-- <br /> j Date Inspected ��/J�7 � <br /> � o <br /> � SEE SKETCH ATTACHED Np, � <br /> � INSPECTI�iN <br /> e <br /> � <br /> r- <br />