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� <br /> � CHART NO. <br /> everett <br /> � <br /> City of Everett I '—'� <br /> � <br /> Sewer Application and Permit <br /> �o. 24295 DATE (�/� �✓�- ����'. <br /> %" <br /> Service Address � Utility Account No. <br /> /�, �! <br /> liilling Address <br /> � Permit Fee� _ <br /> City, State, Zip�b,�.,���,�Tp ���� Connection Charge�s)_ g <br /> J /D _' <br /> Cwner (Mortgagor) Total Fee <br /> Billing Name� <br /> Connection By / <br /> '.'.� <br /> Address_ Signed <br /> Customcr <br /> Phone_ �✓`�f - 6��� <br /> DESCRIPTION: Se��er District <br /> Lot��.5�_ Block�__���r� <br /> � Monthly Sewer Service <br /> Plat (rti� <br /> Unplatted Description Monthly S .ver Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral _ <br /> Remarks: P <br /> Abutting Lot Line <br /> _ /�� , �� � N� g, E, W ft. <br /> _r— <br /> (�� � <br /> �� Approved By �- ' I <br /> Ciry Engineer � <br /> `� ; L� i" <br /> 1 Issued By � � <br /> � / J�� <br /> U / - .� Inspection By I J <br /> � l' � � �� Date Inspected II <br /> � <br /> SEE SKETCH ATTA ED N�• 24Z9S <br /> i <br /> � <br /> INSPECTION I <br />