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J <br /> CHART N0. /yI � i -Z S=s <br /> rverett ' <br /> e� �os^�� . <br /> City of Everett � ' �.s ' � s <br /> �� <br /> Sewer Application and Permit <br /> NO. 22935 DATE �� i� . �i <br /> Service Address �//./ Q���� Utility Account No. <br /> _ _�-- <br /> Billing Address Permit Fee <br /> City, State, Z' ' ����, - ..• ����S'�Connection Charge(s) <br /> Owner (Mortgagor) i d' - - Total Fee —` <br /> � � <br /> Billing Name " ,-ti._ �� / � <br /> I Connection By -z,� Q._- ' <br /> � f" ' �L_-�-- <br /> � Address Signed ,, � ; � ���j�ll `i f'�����: <br /> I � - � CUSIOrtIPf <br /> Phone -�5�- �� �' � <br /> DESCRIPTION: Sewer District <br /> I Lot � Block <br /> IPlat Monthly Sewer Service <br /> Unplatted Description . i=' ' � � Monthly Sewer Constr. <br /> Type Permit: ` Trunk_ <br /> i <br /> ( Lateral <br /> Remarks: <br /> Abutting Lat Line � <br /> N, S, E, W ft. <br /> IApproved By <br /> iCity Eneineer <br /> Issued By _�� <br /> Inspection By � � <br /> ��Q i <br /> — Date I nspected� � �� - / i � <br /> f <br /> SFF SKETCH ATTACHED Np• 22935 ' <br /> INSPECTIOtd <br /> i _ I'; <br />