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i <br /> CHART NO 2 "�— <br /> � everett �� S Gf� <br /> � �; 2 _ z4. - � g' <br /> � City of Everett ���� <br /> � Engineering & Community Services <br /> i <br /> ! Sewe�r Application and Permit <br /> ' <br /> � N0. , DATE • � <br /> � _ . <br /> � Service Address ' � � "� `� '' ' � ��� „'- /��•Utility Account No. " �% � �'''' - `� � <br /> ` Billing Address ��- �J ° y �'� � Permit Fee �'� �' <br /> � �i- <br /> � City, State, Zip �� � ' � � � 'r r U, f✓�• %`� �=� Connection Chargels) ''�� <br /> � 7 �,•'�7 •9.� i; �- > _�" <br /> i Uwner (Mortgagor�� G` �:'i� 7 C" - j Total Fee - <br /> ; Billing Name ' "� �`� � _ <br /> � Ccnnection By � r ' �- �' `- `� • , <br /> i - <br /> . ' ��..�.� / <br /> � Address Signed � ,., : ;,- �. : ,r ! ;_ c____ . <br /> i — <br /> i ,� Customer <br /> Phone � "' ' ' ' � <br /> - � <br /> �' DESCRIPTION: Sewer Distnct_ � / � �� <br /> I <br /> � Lot � % Block -"'-� �� <br /> Plat % ' ~ Monthly Sewer Service � <br /> IUnplatted Description` � Monthly Sewer Constr. <br /> � Trunk �� � �� <br /> Type Permit: .'%�-_ � ,� .�-. '` <br /> I Lateral <br /> � -- <br /> � Remarks: <br /> � Abutting Lot,Li�e <br /> ' �1 S,i�iw � "J _ ft. <br /> f _ - <br /> � <br /> � <br /> � Approved By. <br /> I City Enpineer <br /> � Issued By-' � - � <br /> i <br /> � <br /> � Inspection By ? /"" "-' <br /> � <br /> IDate Inspected___�/ ' �-- <br /> � 3 _ � <br /> SEESKETCH ATTACHED N0. <br /> ' �i�'�f =-CIiU. <br /> 9 �i�', <br /> � � _ _ '4 + . .:�,l. .'[i�:l.,. . .. � <br />