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1 <br /> r � <br /> � , everett CHART N0. � -��-��- S <br /> e <br /> City of Everett ,, <br /> Sewer Application and Permit <br /> N0. Z471$ DATE �/�5�£�S� <br /> � - <br /> U � .�_. <br /> Service Address 3 / ��S�' �2� Utility Account No. <br /> Billing Address����_�����, Permit Fee_ �D ' <br /> City, State. Zip ,�� ���'�T��y�,��� <br /> Connection Charge(s) <br /> Owner (Mortgagor) � <br /> Total Fee �� <br /> Billing Name � <br /> �' " ' � ! . <br /> Connection By �� . _ �aG�,r,��� -r_2� <br /> q � <br /> Address „ <br /> Sign <br /> / n- • ��� 3 Customcr <br /> Phone�3�'�5�, p5--7 <br /> DESCRIPTION: <br /> Sewer District <br /> Lot Block ' <br /> Monthly Sewer Service � <br /> Plat I <br /> Unplatted Description Monthly Sewer Constr. I <br /> Type Permit: " Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line I <br /> N, S, E, W ft. <br /> � <br /> � <br /> Approved By ` � , <br /> City Engmcer <br /> Issued By � <br /> �_ Inspection By � /�.- i'��_ � <br /> Date Inspected � "G- BSl <br /> SEE SKETCH ATTACHED NO. ZQ 11H <br /> . <br /> INSPECTION <br /> �_ <br /> � <br />