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� <br /> CHARTNO. �(� GrJ � <br /> everett � ` <br /> . �'�5�� <br /> � ` <br /> � �z � �� <br /> City of Everett /���� _ - <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> N0. E� � �J � G DATE /-'r-J'-.0 / ;' ; 'r 7/ <br /> ✓ <br /> _,f ''- <.' .i 7 G -' ' t; / <br /> Service Address �� � � f �• � 1� -� '-'� Utility Account No. - <br /> � i- �:,4`-�.a.l..-c. � U. <br /> Billing Address {��—`��'—'""'`'�"� �"�"`�'�'—' Permit Fee s' '�+ <br /> , � ,< , <br /> City, State, Zip ''� .��� _.� ��f� ''` �' Connectiun Charge�s) '- ' � <br /> Owner (Mortgagor) ��'1,_.:-•� .+ ,•.�- .' '*--r' - Total Fee '' � <br /> Billing Name <1-•,- '.-Y � <br /> � <br /> � <br /> Connection By ''� '^• - �\ , <br /> . ` <br /> Address ^ s� '� � -' ' ' � � � Signed c� <br /> Customer <br /> � <br /> Phone <br /> DESCRIPTION: Sewer District �`� - � =" % -�� <br /> Lot � Block , 7 ..., ,"' <br /> Plat �/ � i- ;. Monthly Sewer Service � � - <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk • z 3 <br /> Type Permit: <br /> "� -� Lateral ' f <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> �- _ <br /> J' � <br /> APProved By , ''.i� r=� � <br /> Ciry�Engineer <br /> 1 ,i <br /> � <br /> . Issued By „ '- J <br /> Inspection B <br /> � ��J'1�.J � <br /> Date Inspected _v _�� I <br /> a ISEESKETCH ATTACHED N0. • , <br /> � INI�f iiCIIOP! � �: <br />