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. , ,, _ ,. <br /> CHART N0. ��- -'' -- . ` <br /> everett . ,.� _�� _ �c� <br /> � �-. 1 i ; {.,n, _. ... � _: <br /> City of Everett ��/�, �" <br /> �' � , <br /> , �; <br /> Sewer App�icafion and Perrnit <br /> N0. `�2895 DATE ' _ _ <br /> Service Address Utility Account No. <br /> Billing Address � Permit Fee <br /> City, S[ate, Zip Connection �harge(s) <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> ;� <br /> Address '•� _ Signed � � `�! � � <br /> Cus�omcr <br /> Phone <br /> DESCRIPTION: SewerDistrict • ��� '�- ' <br /> Lot Block <br /> Plat Monthly Sewer Servicc__ _ <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk __ <br /> i : <br /> Lateral <br /> Remarks: <br /> Abut[ing Lot Line <br /> N, S, E, W ft. <br /> � <br /> Approved By_' _ <br /> Gry Engincer <br /> i �" <br /> Issued By � —' �_'.. _ <br /> Inspection By �' r � � <br /> —�� i <br /> .—_ . _ _ ____._ Date Inspected �' '� � ` � / . <br /> SEE SKETCN ATTACHED Na� 22895 <br /> , �:,i i_: 1 iCll <br />