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everett <br /> � � CHART NO. ��=i��" ' � %-- `, � <br /> � ` � /�e 5 �G.�� , ! <br /> ; <br /> City of Everett � / _ � � _�� f� ' <br /> Engineering & Community �vices � J <br /> ���_ _ _ " � <br /> S�wer Appiica+ion and Permit � <br /> � <br /> f q/ <br /> NO. � n rl �t U '� DATE o ��� %)�:� <br /> -, � <br /> Service Address_ �� ��^� �� !�.r�.- '��,��tility Account No. <br /> Billing Address � Permit Fee_ �2 ..,r-;,._s- <br /> City, State, Zip Connection Charge(s) � <br /> I <br /> Owner (Mortgagor) _ �otal Fee_ �'?-,_�-,,,, n 1 <br /> Billing Name I <br /> ,-( � �, �� . ` <br /> i <br /> Connection By ,!� iJ��,_ � . � <br /> . ,r /;�i' , >� . <br /> Address_ U I - � <br /> Signed � G.-c-�� ' l�Y.?Yr�c� <br /> . customcrT� �'-- <br /> Phone <br /> DESCRIPTION: Sewer District__ � <br /> Lot _ Block — <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: �.�z�_ry���,,,.r Trunk <br /> � <br /> '/ Laterai <br /> Remarks: o �� <br /> �� Abutting Lot Line <br /> � N, S, E, W <br /> �U ��� ,��uz�J' l�x-,�e�.L� � —rt. <br /> — <br /> .�=---�' J . <br /> Approved By_ _ .I�:-: ->• <br /> Ciry Eng�neer �— <br /> �...�� . : '�! <br /> Issued By •� - <br /> // ,C i <br /> Inspection By '''� ''' � <br /> p Date Inspected�/��7f � <br /> SEESKETCH ATTACHED NO. <br /> IP1,;1' :C i !C ! <br />