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' CHART NO. "����- •`� <br /> �� everett � � <br /> , �>� ., � � �J I <br /> � e ; <br /> ; <br /> � <br /> ; City of Everett <br /> � Engineering & Community Services , <br /> ; Sew�r Application and Perrnit <br /> � , / <br /> ' N0. � l �; �� ,I_ DATE e��� ^'/ % � <br /> � <br /> i , <br /> i Service Address - ��� %' ' � '��� — Utility Account No. <br /> / ., ,.%� <br /> � Biiling Address ���� ''J`,= '/�"�-�, Permit Fee � • <br /> t � .%%, <br /> ' City, State, Zip[ . �� .<`Y/`-G • ���-•�'� Connection Charge(s) <br /> j ' , � .. � <br /> I pwner (Mortgagor) - �+!-�+ �/ •��'�t Total Fee _ � <br /> I <br /> iBilling Name -�----� <br /> � <br /> � Connection By ' � - <br /> ` Address Signed <br /> Cusmmer <br /> ;� /�� � �� � � <br /> � <br /> Phone •-� � <br /> I <br /> f DESCRIPTION� Sewer District <br /> � � � <br /> Lot =- ' - - % Block �� 5 � <br /> � Monthly Sewer Service <br /> � Plat -�:✓ ; f, . / �•- � <br /> � Unplatted Description Monthly Sewer Constr. <br /> , Trunk <br /> Type Permit: �4,t_.;� ... i ' ' <br /> .� �%e Lateral <br /> Remarks: <br /> I Abutting Lot Line <br /> ` N, S, E, W ft. <br /> I _r��^' n � � � � <br /> � . =�_77..�_„� <br /> t ,(� � ' <br /> t -fi� '� ' (� � Approved By� � �/ <br /> � ,,-/ , <br /> /` _ Ciry Engineer <br /> i <br /> f %�t.� \ <br /> Issued By'=.,' �- ���- r. <br /> � <br /> i <br /> iInspection By—�GQ��""`-`'—" <br /> �� Datelnspected ,�����7 <br /> a / ' <br /> ; SEESKETCH ATTACHED NU.' <br /> ' I NSP6�;�:�� ,f, v <br /> , _,*, _. <br /> ��.. . <br />