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- •- --_. . , <br /> CHART N0._ `` " , <br /> everett <br /> I �`�Si�� �. <br /> � - <br /> City of Everett <br /> �-2� -�� <br /> Engineering & Community Services � <br /> i <br /> Sewer Application and Permit <br /> N0. � E_' J ! � DATE f"' / % /�� Y'� 1 <br /> � <br /> � <br /> Service Address % 3�/ - ' l - -�� � • Utiliry Account No. <br /> .��� <br /> Billing Address --y � --�--� Permit Fee �Q , <br /> : 4 ^' <br /> City,State, Zip� �� i;ti • ��.- �✓ Connection Chargels► I <br /> ? /l�� <br /> Owner (Mortgagor) - '-- � - - Total Fee J !} <br /> Billing Name -`✓ > >�'`�� <br /> Cc,nnection By J� -�— <br /> i <br /> Address Signed � '-* % ,� `"' <br /> � <br /> / custo1her ' <br /> Phone " S �' �� /h <br /> DFSCRIPTION: Sewer District <br /> Lot_.;✓. �-'� Block <br /> Plat _ !� - ( : - ., . Monthly Sewer Service <br /> Unp�atted Description Monthly Sewer Constr. <br /> Type Permit: �/ � � �� Trunk _ <br /> - � <br /> Lateral <br /> Remarks: jC� ,(�. - � -� j - 'h � qbutting Lot Line <br /> �Eil��.-� ��.0 c� /rac+c ; � � � N, S, E. W ft. <br /> Approved By !� <br /> Citv Enqmea ' <br /> Issued By=-� _ �_ <br /> — - -----� ---- Inspection By � l,6��1�� <br /> .- --- ---— ----- Date Inspected��7� <br /> �— <br /> SEE SKETCH ATTACHED NO, � <br /> �,� .. , <br /> .. _�. . . .� . . . - ,� . .. _ . .,. . . . - <br />