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i <br /> CHART NO. � <br /> everett � <br /> e �� :: <br /> City of Everett ' ' - <br /> Engineering & Community Services � , <br /> Sewer Application and Permit �- ; <br /> � <br /> �' NO. Z 2 4 H 5 DATE _ 4f -��� I <br /> � � � <br /> Service Address �^�"11}� � - :-- '_� ' ..�-L <br /> � � `''%'�fltility Account No. <br /> � • J <br /> Billing Address �J�� -�_;�s-�'-C��- Permit Fee /'" �r! <br /> . , � <br /> % � ;'i` ��' J / ����� <br /> City,State, Zip�f_-=�� . /i/� �d��^� Connection Charge(s) <br /> � i � ,. <br /> Owner (Mortgagor) '�'� - /i- �--''. � ' Total Fee "'�' '� <br /> Billing Name � <br /> Connection By --�",' `-- <br /> Address Signed v- ` <br /> cuitomer I'I <br /> Phone- .=> >�' ' � 3 �U <br /> D�ESCRIP'I�: 6 �'/ Sewer District_ I <br /> � Block Y <br /> Plat (� '%� ,'r- /'= • .:j� - MonthlySewerService � <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> , � <br /> APproved Bq • f�: . :-�•-, <br /> �iry Enpmeer <br /> � Issued By_ %� • �-f � <br /> Inspection By _ <br /> � Datelnspected <br /> � <br /> SEE SKETCH ATTACHED Np. 2 2 Q $5 , <br /> INSPECTION — - <br />