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� <br /> feverett • . - - CHART N0.—� "�`�.���-� . <br /> � � <br /> � ._ I <br /> �`�S � �J� � <br /> City of Everett � <br /> Engineering & Community Services � <br /> Sewer Application and Permit - <br /> N�. 21. 878 DATE � - / � � <br /> Service Adoress ' � � / �� � <; ' �1 r ." ':'-'� �:� Utility Account No, .: - � �� -' � -: O - <: � <br /> ` . .. C;;� <br /> � Billing Address �� .� �/� /�' ��c �i /> Permit Fee i�7 <br /> � �� _ � _ .�:_ <br /> City, State; Zip %y �� � !` ' ? Connection Charge{s) � � <br /> � Owner (Mortgagor) 1 ` /� j'/�,t' ;i �.�t� ,- �-i- Total Fee 1�� �'� <br /> � BillingName_ -�� ��� L" <br /> Connection By � '`� ^r� � <br /> � l� <br /> P.ddress_ :u� C�% i' M �;: :�,. �., Signed __. , �,, � J _, s'�%!f"'J✓.� <br /> � .. _ Cusromer <br /> Phone `' � � <br /> i <br /> DESCRIPTION: Sewer District__� U ( .1�L. <br /> Lot � Block <br /> Pfat -- �' '' � + ! - �. - i; Monthly Sewer Service ��'� � 7� ir h t' !i <br /> Unplatted Description Monthly Sewer Constr. <br /> f Type Permit: ., Trunk •^ •.1 ;;" <br /> I ; _ • •- - <br /> � Lateral - . J�� <br /> i Remarks: <br /> Abutting Lot Lin <br /> i N, g. E,� �' ^ ' S"' ft. <br /> i <br /> i <br /> i ,�. . <br /> ; Approved B��— .G� <br /> ' Gry Enginm�• <br /> �. <br /> ; Issued By - r <br /> I ' <br /> I <br /> ���cJ� <br /> i Inspection By_�__��CtiG-'�zcct,�i-� <br /> ,' _ - Date Inspected_ B,��T 7 <br /> 0 <br /> i SEL SKETCH ATTACH[D N0. <br /> � Ii�I��f�i r�l IOf�; <br /> `.c:L <br />