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, <br /> CHART N0. L� � � ZU --s � <br /> everett � <br /> � <br /> �i ��s�� . <br /> City of Everett � ��/� '�� , � <br /> (O � <br /> Engineering & Community Services � <br /> Sewer Application and Permit �� � <br /> N0. �� � jj :} DATE ��' -% -�'y <br /> � ��. ,, ' <br /> Service Address_t f � � "' � _' � • Utility Account No. � <br /> „ � <br /> Billing Address ��' � i�-� '� - ��'- Permit Fee � 4 <br /> �' - <br /> City, State, Zip ' '� �G�% ' '/��'d i Connection Cliarge(s) <br /> ' n/i; � <br /> Owner (Mortgagor) �1'.c - �� - ✓' - Total Fee <br /> Billing Name - = `-�- � <br /> Connection By - - - <br /> Address Signed <br /> Customer <br /> Phone � - % '�0' � <br /> DESCRIPTION: Sewer District <br /> ' Lot /`� Block �� <br /> Plat �«' ;%✓' . � Monthly Sewer Service <br /> Unplatted Descripfon Monthly Sewer Constr. <br /> Type Permit: � Trunk <br /> ;-%� . � r" .. - " :r <br /> � / �i' - Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved B � /:�� <br /> v- <br /> Ciry Enginccr �/�� <br /> Issued By �' . --=� -� i <br /> I <br /> i <br /> _ c " <br /> Inspec[ion B <br /> Date I nspected � ��c.�'" �7 <br /> o � <br /> SEE SKETCH ATTACHED NO. � - � <br /> i�;,iSPFi,Ii�,;' <br /> +.,, <br />