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'" CHART NO._�L�L��= � � <br /> everetl <br /> - �O f%`�� ii <br /> e <br /> City of Everett <br /> Engineering & Community Services . <br /> Sev�ier .Application and Permit <br /> , <br /> N0. l i 1� 2 qF TE �„1 �� i' 7 <br /> '_ <br /> I <br /> Service Address..��L.-� -� �c-`n='-'� ���'`�� Utility Account No. -- <br /> Billiny Address <br /> Permit Fee �`" ''"''� <br /> City, State, Zip Connection Charge�s) ��-r , <br /> Owner (Mortgagor) Total Fee �� - <br /> Billiny Name I <br /> ( � �"' '-� � <br /> Connection By ' �-% r � ''` ' � <br /> ; <br /> Address / � Signed � �ustomer � ��,-� ', <br /> � <br /> Phone � <br /> DESCRIPTION: Sewer District <br /> Lot �j�,� � Block ���� (�onthly Sewer Service <br /> Plat '�� (t , ,.. ,I , i . ,� <br /> Unplatted Description � Monthiy Sewer Constr. <br /> Trunk � <br /> Type Permit: �-,.�(� ,� ✓ <br /> , Lateral <br /> � � <br /> Remarks: / Abutting Lot Line <br /> � N, S, E, W ft. <br /> ,cL' �� <br /> ; ' <br /> o --- <br /> Approved By_.,, .=�; .-; , <br /> „� u . CilyEnglfiter . ' <br /> .� <br /> � o ,/ .� <br /> s <br /> Issued By � <br /> I <br /> � ��' � • �j <br /> Inspection ByS�=�-� �""�'��'' <br /> / <br /> Date Inspected�''"� �2' � S�' 7� <br /> e , <br /> SEE SKETCH ATTACHED '"`� �VO. <br /> �� INSPL=CTION - � <br /> � _ <br />