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CHART NO.�—� �� `5 � <br /> e��erett ` <br /> �D. s �.�'� <br /> e <br /> City of Everett � � i� �, � _ _ i <br /> Engineering & Community Services <br /> Sewer Application and Permit j�'�� <br /> � i <br /> NO. � :� �� ,lt ,DATE , I <br /> I�JfO:> � � ; �:� �:1��-c. � �. <br /> Service Address • Z:� �,_ '��� —�% �' � a Utility Account No. <br /> Billing Address Permit Fee — <br /> City, State, Zip s � ^ ' Connection Charge�s) "''~� '! <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By � `~ � <br /> i i j <br /> Ac iress " Signed � f -- <br /> �ustomcr <br /> Phone _ <br /> DESCRIPTION. Sewer District _ I <br /> Lot Block � <br /> Plat _ Monthly Sewer Service — i <br /> Unpfatted Description _—_ Monthly Sewer Cons•tr. <br /> Trunk <br /> Type PermiL• . I — T— I <br /> Lateral <br /> Remark% '.• Lp- �..���..�i�/�- ,t.�r ` I <br /> '""�' Abutting Lot Line � <br /> � N, S, E, W ft. <br /> — .� <br /> i ' t.�.l-- _��-__�. ' <br /> , � <br /> �-� ; ; - ,�- <br /> CGti'\-v�C[ t' L � � / � : .�� . <br /> �'!' c ^'� � ' � C Approved By� �%� <br /> C'�" �� G� •V/ �.J Z`'� � .J�� /�,L� . �SJ�G � CitV Eng�ncer i <br /> 7 / <br /> — Issued By — - -� — <br /> �� ll✓> > <br /> /.� <br /> i <br /> Inspection Bti. �.�-«� ��--.�..t���-^'-cy, <br /> Datelnspected �i — � 7 — '' 1'" __ <br /> 0 <br /> SEE SKETCH ATTACHED NU• '' <br /> i���sN�_��i ior� <br />