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1 I <br /> CHART NO. �'� �'� � ' -' " " �' <br /> everett <br /> e � , . . <br /> ,`;��> ,. <br /> � � ' 1;�: L <br /> City of Everett ,� <br /> ; (, <br /> 'i,', <br /> Sewer Application and Permit ' " <br /> NO. 24792 DATE �/�� ��� <br /> . �� � Z �� <br /> Service Address Utility Account No. �^ <br /> Billing Address ��a � ���� Permit Fee �� <br /> City,State, Zip �-i��'-o"�� G� �a� �/ Connection Charge�s) � <br /> � ` <br /> �, - ' � ! � Total Fee �� '� � <br /> Owner (Mortgagor�--�y�. <br /> Billing Name <br /> Connection By��,T, � � ���� <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTI N: � Sewer District <br /> Lot ��— Monthiy Sewer Service <br /> Plat r, '•�,ait/7 . <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: /J� <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. � <br /> Approved By � ' <br /> City Engmecr <br /> Issued By <br /> I <br /> Inspection By-�" � ��Le�""�— I <br /> Date I nspected � � � � �Y <br /> SEE SKETCH ATTACHED N0. Z473Z <br /> INSPECTION <br />