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_ _ � <br /> i <br /> J' <br /> � <br /> w CHART N0. —�L'�_ �=%— sf <br /> � everett <br /> � � ,��� ��-.� ,z � <br /> , � <br /> � City of Everett ,.. , <br /> � Engineering & Community Services . � <br /> � Sewer Application and Permit � <br /> ; <br /> � <br /> i N0. � ` �, f ' � <br /> r �_ �� � E) DATE .'' /I-� ��� <br /> � <br /> ' Service Address__ .-' '�� � "�' • � Utility Account No. � <br /> � Billirg Address � �' �'l ,,�`�',��-'L !� Permit Fee ^�� �� <br /> iCitY, State, Zip���, , / ! , %T . ��7' . 7- � Connection Charge�s) J <br /> � A <br /> ' Own:r (Mortgagor) -r .;�,!•i Total Fee ^-J �~ �� <br /> ( f <br /> Biiling Name <..-- <br /> Connection By_ <br /> Address Signed <br /> c" ," <br /> Customer <br /> ; Phone _, — _ =' %/ <br /> � DESCRIPTION: ' Sewer District <br /> �'t — -% Block � �` <br /> Plzt_ `;-� r� . . i f -- .� Monthly Sewer Service <br /> Unplatted �escription Monthly Sewer Constr. <br /> � <br /> ! Type Permit: __ � � _ �.., Trunk <br /> � _ � �� Lateral <br /> I � Remarks: <br /> 1. <br /> ��"'/. Abutting Lo'i Line <br />. �_�R� � � <br /> N, S, E, W ft. <br /> Approved By_'� .��—��, z_-..: r_.. � , <br />' � City Eng�neer / <br /> ! <br /> / <br />; � IssuedBy �'_. , .,_L. ,:,rr ., �. <br /> � — <br /> � <br /> I � <br /> � r <br /> iInspection By�'��—c�-- <br /> o Date Inspected_ Fi'' /���7'7 <br /> SEE SKETCH ATTACHED /NO. <br /> i IfJ�PI i'l-In; : . . <br /> � <br /> � <br />\ <br />