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��.� , a- . <br /> .;.,�� ��'�'`- ff/ 5-Z i-S �. <br /> �t,l�r:N�c: CHART N0. � <br /> evereri sr„` m``<`= ��,- J � <br /> ?�c� z��� ��� I <br /> e � � _ �y_ � � . <br /> �. � <br /> City of Everett j <br /> Engineering & Community Services � <br /> Sewer Application and Permit ; <br /> � <br /> .; , <br /> I Q DATE � ' '�' ' f <br /> rvo. 22 -� , 3 <br /> Service Address � / � � ` '� �`"` Utility Account No. <br /> I <br /> � - - <br /> Billing Address ' � ' ����`��,°._�` �"��'��� ` Permit Fee >O � <br /> - � : <br /> ✓ � <br /> City,State, Zip � '� "��f�-^t� �� � �� � Connection Charge�s) � <br /> -,� <br /> Owner (Mortgagor) �''- � ' ' Total Fee. ' <br /> � <br /> � <br /> Bi�ling Name � <br /> Connection By j <br /> Address Signed ' " — 1 <br /> Customer � <br /> Phone I <br /> � <br /> DESCRIPTION: Sewer District -- ' <br /> � <br /> Lot Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk — <br /> Type Permit: <br /> � Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> _ <br /> I <br /> � <br /> —I Approved BY <br /> Crty En9mecr <br /> Issued B�• - - <br /> � : � � <br /> Inspectior By ' -� ! ? , '•r'��•., � <br /> — � /,��_ j <br /> Date I n;;pected � <br /> 3 _ _ — <br /> SFE SI<ETCH ATTACHED <br /> 0F1'e( # 'iv�.;��,s <br /> .`V� . . .�,. '3� � �l— �r �WI� <br /> ��hY y�.�,j y�` <br /> �'���°Jf��93�fi� r <br />