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� CHART N0. � �� —z 9 s <br /> everett � <br /> , <br /> �s i�.� <br /> � , � <br /> City of Everett //~� �" �� <br /> � '" ' "on and Permi� �� I <br /> Sewer Ap�c�nt� . <br /> No. 23245 DATE r1'/ • ,% •� <br /> Q �l� % ' Utiliry Ar.count No. <br /> Service Address�- — ; :l-- <br /> ' . Permit Fee � <br /> 8illing Address <br /> ��� Connection Chargels) <br /> City,State, Zip `_ <br /> Owner (Mortgagor) <br /> j� • % � Total Fee I <br /> Billing Name <br /> Connection By <br /> Signed <br /> AdC�f@SS Cusmmer <br /> rj ' . <br /> Phone <br /> DESCRIPTION: Sewer District <br /> � r � <br /> Lot Block � Monthly Sewer Service � <br /> Plat I <br /> Unplatted Description _Monthly Sewer Constr. <br /> ` � Trunk <br /> � Type Permit: <br /> Lateral_ ; <br /> `.: <br /> Remarks: Abutting Lot Line <br /> N, S, E. W_ ft. <br /> � <br /> �., � <br /> Approved By " ' . — <br /> Ciry i:ngineer <br /> Issued By -----�— <br /> i <br /> S <br /> ' Inspection By ���-R-- <br />