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� <br /> CHART N0. � � - 2g � � <br /> eve aK � <br /> P�ss�� 3-ZS-� � <br /> City of Everett � <br /> Sewer A��licati�on and Permit <br /> N0. G39OL DATE �- »- �I <br /> Service Address��� .. ` - Utility Account No. <br /> %'� <br /> Billing Address � �' Permit Fee_��� <br /> _ ���— !{/ - Connection Chargels) <br /> Citv, State, Zip � �'U p. <br /> � " . �� <br /> Owner (Mortgagor) Total Fee — <br /> Billing Name <br /> : <br /> Connection Ry <br /> Address - - � , Signed c�:mm�� <br /> Phone ✓�37 � �� �'zJ 0 <br /> DESCRIPTION: Sewer Disvict - <br /> Lot_ Block Monthly Sewer Service I <br /> Plat ' / <br /> Unplatted Description Monthly Sewer Constr. i <br /> Trunk � <br /> Type Permit: <br /> - Lateral I <br /> � Remarks: Abutting Lot Line I <br /> � N S E W ft. I <br /> 'I' I <br /> � � <br /> //� i <br /> Approved By ���=z�r�"--- I <br /> / i <br /> � Issued By��� I <br /> i� <br /> i , <br /> ,� . Inspection B� y/� .` "" � — � <br /> � <br /> � � -/ �% - b_/ <br /> _ Date Inspected_ � I <br /> SEE SKETCH ATTACHED No. 23902 ! <br /> INSPECiION <br /> I <br />