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I <br />� everetl <br />I � <br />� <br />; <br />i City of Everett <br />� Engineering & Community Services <br />� Sev�rer Application and Permit <br />CHART N0. �' �— z- �— S� <br />;.'��f� 5 �TL= � <br />N0. �' f�`� i) `, DATE i.�- :/�i' �— <br />i � - �-;� j' /. <br />Service Address��= ^ � %=` : ! ' � �-�• - -�L Utility Account No. <br />Billing Address <br />s - .s - � � <br />✓"�''f� <br />Permit Fee �---" <br />City, State, Zip Connection Charge!s) `f__� <br />Owner (Mortgagor) '- � �� � Total Fee -'`- �--- <br />Billin� Name <br />— y�. <br />Connection By r ' / <br />% ' . <br />Address �j Signed ' � -- - " %�'_ <br />Custamer <br />Phone _ <br />DESCRIPTION: SewerDistrict_ � - �� � _ <br />Lot �� Block � • 5 U <br />Plat Monthly Sewer Service <br />Unplatted Description �`~` %� /_ v= • �� Monthly Sewer Constr. <br />�fvoe Permit: � ,. . _ <br />f9 <br />SEE SKETCH ATTACHED <br />� '_ .. - i� -- .Cr "S' <br />� It�� <br />Ti <br />Lateral <br />ng Lot Line <br />N, S, E, W <br />;� . .. �� <br />_./U <br />ued By � <br />Ciry Engincer <br />B Y /: <br />� <br />^ ��:ion By i"'r.. � 1' �i..,.�.�_, ' <br />ispected ��j '- -� % ' 7 .Y <br />� N�. _ ,.� L �_� :J <br />.. ._k_ a � . . ..... . _ . <br />