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� <br /> CHART NO. � — - <br /> everett <br /> e .� � ,_Y , , A, <br /> ���-�� �-,� , . <br /> City of Everett � <br /> Seyver Application and Permit � <br /> N0. G3164 DATE �/% /%�- <br /> � <br /> Service Address_�� � �G �-��" Utility Account No. <br /> Billing Address, � " ��•- Permit Fee ' / <br /> City, State, Zip i � Connection Chargels) <br /> Owner (Mortgagor) / Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> cu:tomcr <br /> Phone � <br /> DESCRIPTION: Sewer District <br /> Lot � Block Monthly Sewer Service <br /> Plat � <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk � <br /> Type Permit: � <br /> i' L ateral <br /> Remarks Abutting Lot Line <br /> N S E W ft. <br /> J � � <br /> I !� _ Approved By " <br /> Ciry Engmeer <br /> Issued By --� <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED N0. Z316� <br /> RJSPECTION <br />