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CHART N0. K�ZO �Z9�,] <br /> everen �O s �--�r,� <br /> � e /e - T - 7S <br /> City of Everett /' �—" ' <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> NO. ? .� �. ' ` DATE I/����.� <br /> Service Address 7 � ��� - - `� Utility Account No. <br /> BiNia�kdsksss r'' � �' O --_ /" i v Permit Fee : ,�,•-_.�,� <br /> _�-� <br /> City,State, Zip Connection Charge�s) <br /> IOwner (Mortgagor�_ Total Fee ` - --'� <br /> f <br /> Billing Name <br /> Connection By +�'�{-� � '�_ <br /> � ; � i _x._,�__._ r <br /> Address Signed <br /> customcr <br /> Phone_ <br /> DESCR�TION: Sewer District <br /> Lot %�' l- � Block FU z <br /> �— � Monthly Sewer Service <br /> Plat �I, ` �.� `:�_ � 7�' <br /> Unplatted Description Monthly Sewer Constr. <br /> _ Trunk <br /> Type Permit: ,-�•- .-:_� - <br /> Latenl � <br /> Remarks: �� y � S, <br /> � ��C� Abutting Lot Line <br /> ' ,-,%.� �r� N, S, E, W— ft. <br /> L <br /> �.���/ �� // • . <br /> / <br /> ` E1PProved By_. ' ,: ( !- > <br /> Ciry Engincer �� <br /> Issued By " - �'�=� <br /> � I nspection By ��-�-�� . �-d"r-�� <br /> � Date I nspected < "�' i ' � � <br /> i a <br /> � SEESKETCH ATTACHED NO. <br /> � I��I`=i'�:C I li�i�l <br /> � :ti.y . <br /> � <br />