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� .. �loT� oN C4l�R � CHART N0._ � �"' `� `���9- <br /> everett �,_�,,_,�. � , <br /> o� �C d <br /> e _ , 9 _ � � <br /> _ � <br /> City uf Everett A� � <br /> Engineering & Community Services �� <br /> Sewer Application and Permit <br /> NO. � � � ;� � DATE '- /�'= �' 7 <br /> � - „ . <br /> Service Address �`' ^ - - Utility Account No. .� - 1 � " �� �' ` � <br /> � o�, <br /> BillingAddress � ' 'J 1 `/ �� r � , `� Permit Fee lU � .v <br /> � i���_�� <br /> City, State, Zip � / '� '� • '� ��� �% !� ����-'� Connection Charge�s) ��! <br /> �, <br /> i :� <br /> Owner (Mortgagor) 't � � '� '�� �� � � '�'� Total Fee J �' <br /> BillingName �'� '`/ �' �"_ <br /> Connection By ' � '�� � � <br /> Address Signed � - "v� � �� ��`%k!, <br /> J � .— <br /> � Cusmmer �'�j <br /> Phone ' 7" �� �' `'� <br /> DESCRIPTION: Sewer District � 7 r � <br /> Lot ^ •�� Block ��'3' � "` <br /> Plat�-f' - '•�;=->:�= ,!. - �- � Monthly Sewer Service � <br /> Unplatted Description Monthly Sewer Constr. <br /> . .— <br /> «� Trunk .-= � � <br /> Type Permit: .��;..,� r � �; .. . - <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W fL <br /> 4 APProved By'' ' :'-i' - <br /> Ciry Engmeet <br /> IIssued By _ �, <br /> Inspecton By k{'� ���� ���-�-+4 � <br /> o ___ Date Inspected Y��7 8 <br /> � <br /> SEE SKETCH ATTACHED N0. �. .- � ;� ; <br /> i I?�..., ._,'I I . <br /> � <br /> 1 . . . <br />