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: , CHART N0. 'f�' t0 -' !` • <br /> everett <br /> � � <br /> � <br /> I City of Everetc <br /> fEngineering & Comrnuiiity Ser�ices <br /> I Sewer Applic�tion and Permit � <br /> � <br /> N0. � �_ �y (; .j DF>TE %�i`.'�J � <br /> � ServicePddress -' �� '�� '�) '4 "s" ' UtilityAccountNo. <br /> Billing Address ` ' � �� �� -''� ' Permit f-ee /G �-� <br /> i - — <br /> City,State, Zip / : � � / � ' Connection Charge(s) ' <br /> Owner (Mortgayor) Total Fee i��� �`-�---- <br /> Billing Name <br />� Connection By �-- / ' Y " �� %-� v . � �_ <br /> Address Signed <br /> � Customcr — <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Block <br />, Plat_ Monthly Sewer Service <br /> Unplatted Description . -f --� Monthly Sewer Ccnstr. <br /> Type Permit: i�' � - � � ;-> Trunk— <br /> Lateral <br /> Remarks:. <br /> �— Abutting Lot Line <br /> N, S, E, bV ft. <br />. , � � <br /> �L D� .Z �/(/, <br /> � Approved By - _ ,�1: _. _. .� <br /> � Qty Enginecr � <br />, � Issued By� ._=5,_ _�: j- <br /> � ! <br /> I � <br /> Inspection By� .,- - <br /> � o - Date Inspected 4 - �1 / � 7 '7 <br /> , <br /> � SEESKETCH ATTPCHED NO. <br /> IIl,;, �f C�IIOi�! <br />