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et CHART N0. ,�—I - — <br />everett <br />120 A!!!�' <br />City of Everett <br />Engineering & Community Services l <br />Sewer Application and Peirmit <br />No. 2215I DATE -�U- 7,A <br />i <br />r l l <br />Service Address 1 1,03 Utility Account No <br />Billing Address Permit Fee <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By�,:� G, - 7— <br />Address / <br />DESCRIPTION: <br />Lot%=i_ Block_ �S <br />T _�-- <br />Plat <br />U•tplatted Descr <br />Type Permit: <br />Remarks: <br />9 <br />SEE SKETCH ATTACHED <br />Connection Charge(s) <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral _ <br />Abutting Lot Line <br />N, S, E, W___ ft <br />INSPECTION <br />Approved By-� ! - <br />City Engineer <br />Issued By. <br />Inspection By <br />Date Inspected �2 - / 7 — 7 9 <br />NO. L�1 <br />