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, �, <br /> � CHART N � <br /> ievereri �Q f ! � r' ��� <br /> I � Z _ �,� .. 7 �` '. ; <br /> � <br /> Ciry of Everett <br /> Engineering & Community Services �I���� <br /> , Sewer Application and Permit ' <br /> � <br /> � N0. � �. :.; _�. � DATE :•i � �"i <br /> � <br /> � � <br /> � Service Address '.� � � "' %'-- , r �-" Utility Account No. % - ��- �%' � %'- �� <br /> !�� <br /> � B�Iling Address ' � ' � / Ui=� L i �: Permit Fee � u <br /> / ;�_^- <br /> City, State, Zip �"7 ,:i;�Yi '�'�--'U.� Connection Charge(s) / ��� <br /> I� - / ;f: <br /> Owner (Mortgagor) ' _• %�� +','.- �_i-- - . ,./ Total Fee ' � <br /> i � <br /> �f Billing Name =--�' <br /> f Connection By - --' `—' , '` <br /> Address Signed_��i�� J6l,��G�_ <br /> i <br /> Cust er <br /> � Phone ' '% '- i`� V i' <br /> DESCRIPTION: Sewer District %�� ' / <br /> Lot - Block <br /> ; P�at � Monthly Sewer Service �� <br /> � Unplatted Description Monthly Sewer Constr. <br /> � <br /> � .� <br /> Type Permit: """ Trunk /� <br /> � <br /> � Lateral <br /> fRemarks: <br /> 4 Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> 1 <br /> i _,.. <br /> � APProved By f`'-'' <br /> Cny Engmcer <br /> ; 1 <br /> � Issued By ' t <br /> i <br /> i <br /> I <br /> � <br /> t <br /> � Inspection By ,��'�!�d��r4l�z?r� <br /> Date Inspected �' <br /> i � <br /> ;al �' ..i , <br /> � SEE SKETCH ATTACHED N0. _ . _� <br /> Ii�dSPECTI�ifJ <br /> , f.' __ . -�-' -- <br />