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CHART N � ��� `�`Oy <br /> everetl :. � <br /> � �asT`'� <br /> l� � Q" � � : <br /> City of Everett <br /> Engineering 3� Community Services /�i`� _' ` <br /> • <br /> Sewer Application and Permit � <br /> N o. 2 2 315 DATE �/ �' S �,l i'� � L L r3 K_T <br /> Service Addres;��� y /�:- �- ��. -:-t,� Utility Account No. <br /> ` �/ ' 'i <br /> Billing Ar+�ress� / G'?� ><'l�%' C� -%lj •J�a% Permit Fee � ��f <br /> -� ,• — <br /> i ,l� <br /> City, `3tate, Zip�_'L •�•- - .✓ �<�� • f1i/.;�lJ Connection Charge(s) <br /> • , , y � <br /> O��.ner (Mortga,c,or) 1�' ' i_-'�� f'�'C� :L, '�G�• Total Fee �"2 �� <br /> BillingName_ -'�� ,-<-� � <br /> Connection By, --"`��' - --.-�-� � <br /> Address f��d.-�� ^''0 �`f ;'-. c.. .,%•// Signed � j <br /> .� f�O Customcr J <br /> Phone �%�" !' i <br /> DESCRIPTION: Sewer District <br /> Lot��- � � Block ��=� <br /> Plat�� ��:�� �'✓ ' Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: �,g,:7- �,�" Trunk <br /> �' ;:� Lateral • <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> --l`'.� � - <br /> — .-�• / <br /> Approved By �.� `-'� <br /> ` Gty Engineer �, <br /> r-:: % � <br /> , <br /> Issued By �= - �--��"- . <br /> Inspection By � ,r-et<n-✓ <br /> 0 <br /> — Date Inspected ��y ��� �/J <br /> SEE SKETCH ATTACHED N0. <br /> . .�._. ;�.� . �� ��� '�'GCIIC'� � _ <br /> _:, � � .t+��"� ; ��l.. ' �. :,.: n ., ... ...t.. <br />