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` CHART N -� � 1�_ ; <br /> Eeverett <br /> t /voS T�"O , <br /> � e _ ,o _ � g � <br /> , � <br /> � <br /> City of Everett /� <br /> Engineering & Community Services ' ' <br /> � <br /> Sewer Application and Permit <br /> N0. ;� % �� � �j DATE I�I�7 7 � <br /> � Service Address ��� u �--��`� � `-����� '�-� ' �-�Utility Account No. --�"" � a `- `�-� "�--' �- <br /> Billing Address � L� �-��`<' � Permit Fee <br /> _�_..,� ��u <br /> City, State, Zip �v��' E=7%' �'''� l[r'l Connection Charge(s) �')r�`-�� �t� �F , <br /> � <br /> Owner (Mortgagor) `-�t-��' �'�'�•:_ � ��c ,'••�. " Total Fee �'(:-� r 4 ; <br /> BillingName ... l_�ct��c�,s� �-,C�f., � _ � <br /> ConnectionBy ��a<<-"-'���•-.�. �-�,ti-« ` , <br /> Address_� `�- uOYT Signed r � "f% 1 t I <br /> � � Customer � I� <br /> Phone ��� � - �(7-7 v _.. i <br /> DESCRIPTION: SewerDistrict �d- �'�-�=a��"' � <br /> Lot I ;_. Block 'Z�. •� C� � <br /> Plai C'"�L-E-��// � - ����--'-� Monthly Sewer Service <br /> i <br /> Unplatted Description Monthly Sewer Constr. i <br /> Trunk � ���'' i <br /> Type Permit: �,�'ct�- ' <br /> Lateral `L� � U � <br /> Remarks: <br /> Abutting Lot Line i � <br /> N, S, E, W ft, i <br /> � <br /> APProved BY-� ' {�G;v/JI U �.� I �'" <br /> Ciry Engincer '� <br /> / � <br /> Issu�d By .• l.-AC.C•!� fj-;O-.c..J <br /> /� /7� i <br /> Inspection By����f �-.---� ' <br /> � � ----_ Date I nspected 7 ��7_ � <br /> � SEE SKETCN ATTACHED N0. , <br /> INSP[CTIOtI <br /> � <br />