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everett CHqRT NOG- -`�-��- � <br /> � � <br /> �O $' / �.� <br /> ' City of Everett /1, — C �- � � ; <br /> Engineering & Community Services ! <br /> S�ewer Appliceafion �nd Permit ��`�� � � <br /> ; <br /> rv o. � . :� -: . , � _ , <br /> , <br /> _ ._. , __ . DATE �.:.J- /- /k <br /> ; <br /> � <br /> i <br /> Service Address =•'� � � �� i <br /> Utility Arcoun[ No. <br /> Billing Address <br /> Permit f ee ' ; <br /> City, State, Zip Connection Charge�s) !' <br /> Owner (Mortgagor) � <br /> _ Total Fee_.___ ---�,.-,.-,._._ - <br /> Billing Name � <br /> Connection By r .-,.�� i <br /> ; �- { <br /> Address / �f Signed_ _ ^-->+ � > / _%� �, ' <br /> Phone Cus�omer <br /> DESCRIPTION: <br /> Lot Sewer District <br /> Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description � <br /> Monthly Sewer Constr. ; <br /> Type Permit: _ ' ' Trunk i <br /> •�i - <br /> Remarks: Lateral ; <br /> Abutting Lot Line ' <br /> L�.�ii N. S, E, W— ft. ' <br /> ,ne� l�-✓ /' Z/ rPi <br /> �il'��� ; , i <br /> �� <br /> � Q`�-� •�/• d- � <br /> _ �;j <br /> - APProve'cTBy..- ,,,/.,_, <br /> � Ciry Engineer , <br /> � <br /> _. Issued By�_- � � <br /> --�. <br /> --- Inspection By (�/�Y� //�lGfa.2 <br /> `•� Date I nspected_1� - � � f/ <br /> "w" SEE SKETCH ATTACHED <br /> _�,�^+em��.,._w,.�-__..��..---T.__,__ N0. � , <br /> . . _ . . . . . � _ 1 � <br /> . �•. x.� ;.,.. .�:,n ��'��, <br /> - -- � <br /> � <br />