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i <br /> , <br /> i CHART NO./�"� �f — ='-`i' J � <br /> � everett ,� <br /> � _ <br /> . � , �� j / �� f� ' <br /> -� �'� <br /> 1 <br /> S_ � ,, <br /> City of Everett <br /> � Engineering & Community Services : ,) ,�= <br /> i Sewer Appiication and Per�nit <br /> , N O. _ i ;' '_� ' DATE ' �'`' �7:✓ �- <br /> i � - - <br /> . <br /> iSer��ice Address �y�� '-� '" � Utility Account No. _ <br /> ' Billing Address Permit Fee "� '= ' -' �- �-- <br /> i <br /> �,�_�-.' <br /> City, S[ate, Zip Connection Chargels)_ <br /> � Owner (Mortgagor� Total Fec___ _:____ ___� __ _ <br /> � Billing Name <br /> � • � � � <br /> ; Connection By ( �..-L.• ,,� f <br /> Address ,•�� Signed � - i - �� <br /> � Customer �--j <br /> Phone <br /> DESCRIPTION: Sewer District_ <br /> i Lot Block <br /> i Plat <br /> Monthly Sewer Service__ <br /> Unplatted Description Monthly Sewer Constr. <br /> i <br /> � Type Permit: ,-�._: ;_.. ,</ Trunk_ <br /> Lateral <br /> ` Remarks: � - <br /> i �y utting Lot Line <br /> ' �• s� N, S, E, W ft. <br /> � <br /> i <br /> Approved By <br /> '. Ciry Engineer , <br /> � �SSUB� By - _ �.� _ <br /> � <br /> I <br /> �' <br /> - � ' � <br /> i Inspection By ' , .�-• '.�� <br /> � Date Inspected�= � � "' 7 � <br /> I 3 <br /> , SEESKETCH ATTACHED N0. ' , <br /> If`15PFC110�J <br /> � :� <br /> � ---,._ _^r_-.` -�n z,.. . . _, _. _ _ _ ;-� - . - -- � . _. n::, <br />