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ii; . <br /> CHART NO.� _ ,i . .;"" <br /> everett <br /> i`Io�=' �� 0 �� 6 �os7�/� = <br /> e Za .�� <br /> � <br /> City of Everett Q� <br /> Engineering & Community Services � <br /> Sewer Application and Permit <br /> N0. `�' � �j i ( f DATE : � � � <br /> Ii <br /> Service Address % � Utility Account No. �" �" � <br /> Billing Address- ' / ' " ' ��; Permit Fee � <br /> City, State, Zip � -"✓ . ;: Connection Chargelsl ' �`' � <br /> Owner (Mortgagor) Total Fee <br /> Billing Name ---� <br /> Connection By — <br /> Address Signed --- <br /> Customer <br /> ,. �� -. .% �. . <br /> Phone <br /> DESCRIPTION: Sewer District : '� <br /> Lot Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> i : ,. <br /> Type Permit: -' <br /> lrunk �' / ' <br /> — " __ <br /> — Lateral -' <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By � <br /> Cily Engineer . + <br /> i <br /> Issued By _ � <br /> /� <br /> Inspection By"'��- ` T— C�-� �` <br /> i <br /> Q Date Inspected � ' � ? — 7� � <br /> SEE SKETCH ATTACHED NO. <br /> IMSP[CliON <br />