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CHART N0. ^ �� �� 2�-y I <br /> everett " ! <br /> ��r, , <br /> � I � �� �' .: � <br /> City of Everett � ��•�/ „ � � <br /> 4 : <br /> Engineering & Community Services � <br /> Sev�rer i4pplicatdorl and Fermit � � . ; <br /> N0. � �' f_; ijf) DATE �� -,��' �� �� <br /> Service Address � ��� � '� �� ' '�'-l:Ftility Account No. �y��� � <br /> ��- <br /> Billing Address !�� � � Permit Fee J '� � <br /> ;' � �=_ <br /> City,State, Zip - � . '.�< • i .• ��L Connection Charge(s) r� �; <br /> � t � � rJ �'r'� i <br /> Owner (Mortgagor) � % % Total Fee , <br /> Billing Name - �.— <br /> i <br /> Connection By -�". '-- 1 <br /> Address Signed_ ���'Yy�/Cl� .�(/�(�L����� <br /> ' Customer � <br /> Phone- 11l — ' %� 7 '. <br /> DESCRIPTION: Sewer District.� � �� / Z� � <br /> �'�, l , <br /> Lot > Block � I <br /> Plat "- ',� Monthly Sewer Service ��-� � %-f--'< � � <br /> t <br /> Unplatted Description Monthly Sewer Constr. � <br /> // ; <br /> --- Trunk 7• ='� � >• - '�� <br /> Type Permit � ' ' � � � <br /> � c <br /> ^'-- � � <br /> Lateral h . DO y/�� :�' � <br /> Remarkr. I <br /> Abutting Lot Line� , <br /> N, S. E,LJ11..-" � �' `-'� _. ft. I <br /> � � <br /> _ <br /> I <br /> I <br /> :l-� ��;� � � <br /> Approved By <br /> City Engineer ' <br /> �: i <br /> Issued By ^ � ---=-^ � { <br /> I <br /> i <br /> ! - � 1 <br /> Inspection B � `� ._ ' <br /> � <br /> Date Inspected��' 9- �� � <br /> a <br /> SEE SKETCH ATTACHED N0. _. . ' :) <br /> W�PECTlO N <br /> I ' ' <br />