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! CHART fd0./l�_���� <br /> everett <br /> ,i'a��T�"�' : <br /> ► e Z -� � - � �- -. <br /> � <br /> I City of Everett Il�r�l �/ w�r� <br /> � Engineering & Community Services ��M • <br /> Sewer Application and Permit . <br /> N0. i r U � � DATE ��-���,�7 J' <br /> Service Address �y�� -��"--/ /��->' r� '� f�"/ Utility Account No. "' -' F=-���-U`� ' <br /> Billing Address -��V->d3 r �7!� L:<, r-� �/ • Permit Fee �°' � <br /> �i <br /> City,State, Zip���>- ,!. ���/� _ : � r:�� .^�� ConnectionCharge(s) ^��� <br /> - ' /voy3 q9-' �. <br /> Owner (Mortgagor) ��^"'- %�- � "� Total Fee -�U <br /> Billing Name -��• <br /> Connection By - � '' <br /> .� <br /> I Address Signed �� Q ,�� ��"`S.L-� ��� <br /> + � Customer ' `,� � <br /> Phonc ��'� - "' � �.'' <br /> �. <br /> DESCRIP710N: Sewer District ,'� %�• � � _ <br /> Lot f _ Block � � �,�. �r ;J � � <br /> Plat / • _ / ��:;<- _.f Monthly Sewer Service <br /> Unplatted Description ,3 � A . Monthly Sewer Constr. <br /> � I <br /> Type Permit: � , ( ° ., � Trunk �' �S '. <br /> - � <br /> Laterai <br /> Remarks: �� <br /> Abutting Lot Line <br /> N, S, E, W ft <br /> � <br /> • I <br /> f APProved By�� •. ' l�-. � <br /> City Engineer <br /> ` t. f� ..� <br /> Issued By �. <br /> Inspec;on By � • �'-���A-�� � <br /> � Q Date Inspected_ �_� 3 '�� � <br /> � SFE SKETCH ATTACHED NO. <br /> IPJSPcC�IOf�I <br /> ,,,. _ . <br />