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everen 4 CHART NO.�' V� � <br /> e ,�a s �� <br /> -- 9 -z.� _ � g� <br /> City of Everett <br /> ,, .� , ' Enryineering & Community Services � /�'�C��f <br /> sf - ����. <br /> °�'' Sewer Application and Permit <br /> NO. 2 2 �J Y� R� DATE �/�`� L�!` <br /> Service Address���-=� r �--- .- <. i /. — Utility Account No. <br /> Billing Address Permit Fee -,-- . - �- <br /> City, State, Zip Connection Charge�s) <br /> Owner (Mortgagor) Total Fee .-� <br /> Billing Name <br /> ,-�i ' f�� _.G_ <br /> Connection By I �„r � , . � <br /> Address f '� Signed � - . - <br /> Phone / Customer <br /> � <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description Montlily Sewer Constr. <br /> Type Permit: 7: __ � ' Trunk <br /> Lateral � <br /> Remarks: ' <br /> � Abutting Lot Line <br /> "��` N, S, E, W_ ft. <br /> �.. - �/„ , <br /> � —_ I <br /> ---�-��� LY� �+-�"��,� mn APProved'�j . -- �;. <br /> Ciry Engineer <br /> —�/ � ' �y l�.� } Issued By � • -� / i <br /> � 3 <br /> � ' ��, � <br /> Inspection By ,[��_ <br /> o Date Inspected � <br /> � <br /> SEE SKEICH qTTACHED N0. i <br /> �': � ! <br /> i�l � <br />