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everen CHART NO����� <br /> pos��� <br /> � e e _ 9 _ �a : <br /> , <br /> City of Everett �w �_ L� <br /> /�J�T <br /> Engineering & Community Servir�s ' <br /> Sewer Application and Permit <br /> ING. 2i � ( �,i DATE _� �;%'/ <br /> � <br /> Service Address �✓-� �" � �",' ' v Utility Account No. <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Charge(s) -�"'`� <br /> Owner (Mortgagor�_ Total Fee - <br /> Billing Name <br /> � � � � <br /> Connection By � ��- � <br /> �i `� ' -, <br /> Address .i 5J � Signed r , � _�-,��- >-:.. � <br /> cuscomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot �_I__f�__ Block—/ �. � <br /> Monthl SewerService <br /> Plat � % ._d /. !� f._.d Y <br /> Unplatted Description Monthly Sewer Constr. <br /> - Trunk <br /> Type Permit: -�.. .. . -, ,, � . . <br /> Lateral <br /> Remarks: � , �, _ti Cc.�ccr��i � �.� <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> . <br /> Approved By,�- .'i. <br /> Gq�Enginecr <br /> i <br /> Issued By - :• -. 1 <br /> —T <br /> � /� <br /> ; Inspection By C� -"'.�---Q-�n-r-s' <br /> i <br /> Date Inspected `� — �i - 7 � <br /> 0 <br /> SEESKETCH ATTACHED N0. <br /> I I'�Il;i'LCl�ii�bi <br /> � _ . <br />