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j CHART NO.�=s��� <br /> everett ( _ _ _ <br /> � �� -, � ' �� <br /> � � - � � � <br /> iCity of Everett / ��� � � <br /> , <br /> � Engineering .i Community Services -- ' <br /> iSewer Application and Permit �� _ �� —�� <br /> i - / - <br /> � N0. � r: � 3 1 DATE li� �// :' <br /> I <br /> i , � <br /> � Service Address � �� %' `% -L' UfiliYy'Account No. — <br /> � <br /> � Billing Address �'�� � "'��'L� Permit Fee - <br /> � <br /> ` City, State, Zip Connection Charge�s) <br /> i <br /> ' Owner (Mortgagor) <br /> / . i ,' Total Fee_ <br /> ` Billing Name - <br /> � __ <br /> � -�- <br /> � Connection By <br /> I � , <br /> Address Signed + <br /> Cusmmer <br /> ( Phone - <br /> � DESCRIPTION: Sewer District `� <br /> � Lot � Biock Monthly Sewer Service <br /> fPlat �' <br /> i Unplatted Description Monthly Sewer Constr. <br /> iTrunk - � -- <br /> Type Permit: � <br /> ; Lateral - - % <br /> f Remarks: n.i-�. -.cc ac�... O �. ���1� � <br /> ( � Abutting Lot Line � <br /> I • • /� r ft. <br /> I . , .yccr-�-�-v � S� c� o� A N, S, E, W , <br /> r � � ',� <br /> k , � � � <br /> ., � <br /> ; <br /> , <br /> � � <br /> Approved By <br /> i <br /> Ciry Enginecr <br /> iIssued By ' <br /> i <br /> f (�Gr` '/" .-r_:�.,y.a.a�"'_`� <br /> I Inspection By_ -, <br /> I �,. <br /> iD�te I nspected �- � -- �' <br /> � a <br /> � SEESKETCH ATTACHED N0. <br /> � �;�,�,:�*!�' ��i ! <br /> i . <br />