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. . j <br /> everett CHART N0._� '' <br /> � ��� S `. Lf �� <br /> � 2- - Z - ? � . <br /> City of Everett �� ��� ! <br /> Engineering & Community Services <br /> Sewer Appl�cation and Permit � ; <br /> ; <br /> NO. ;_ �� 4 �� �_' DATE _ �- � ' �� i� � <br /> ScrviceAddress �`.�%c� - .-�' 7� �;-, UtilityAccount No._.�- ��- �<- - ��� <br /> . i - y <br /> Billing Address '� ' l.� / f� �/ ' �/ �ri Permit Fee_ <br /> � <br /> City, State, Zip_ "� �%� . ��-='ri ?� Connection Charge(s) � -•� <br /> O�vner (Mortgagor) J �� �Total Fee ' <br /> � % — <br /> Billing Name � � � <br /> r <br /> �' � <br /> Connection By r � � <br /> . ,I�' - <br /> i <br /> Address_ �s�G / "%/--� o, �� • Signed �.� w �-. � ✓��� �'> <br /> Cuitor/tCr � <br /> Phone— ; ` � _ =�% •/�- <br /> " DESCRIPTION: Sewer District � / _.'�,--. .( / % <br /> Lot_ �� glock <br /> Plat i' _,�� . Monthly Sewei Service r+' • 5� <br /> Unplatted Description Monthly Sewer Constr. <br /> -- � <br /> Type PermiL• "i- � _ Trunk_ f • �=� , <br /> � . � ,, <br /> Lateral - � � ' �i r <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W it. <br /> Approved By. ;;�� <br /> " Gry Enpinerr <br /> � <br /> Issued By' - <br /> _ Inspection By ` �-�.N(,�n� <br /> ; ----- --- ----- Date Inspected_ // 7� ��_ <br /> SEE SKETCH ATTACHED N� �, i <br /> �- �- � , <br /> e Y_"• �K � . i.l�—�j� 5� ' 'h '� - . y �.S <br /> , . ,.... �,�. .. . ". .y . <br /> .�. . ... , � .. .... .,--r ... �'- � . �_..:�. .{ -, <br />