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�� �� � � <br /> � CHART N0. ��" � <br /> everett � ' �� <br /> �t��, � <br /> ,,y� � -�3��� <br /> City of Everett � <br /> Engineering & Community Services ' <br /> Sewer Application arid Permat ; <br /> � <br /> NO. �� �_' ,-. ''� _E. DATE � � � i <br /> Utility Account No. � <br /> Service Address �'� � � ` � <br /> S, . ' 1 <br /> Billing Address <br /> ; ? 7 r � %�.: r-�i� �. -+�( Permit Fee � <br /> F ,) j! Connection Charge�s) `' �'` ' ' <br /> City,State, Zip ' � '`' iv`�"� � - ' <br /> ,�r� ' <br /> ;.F._, !� t:n_, � ,),/�.> � /-�' TotalFee I <br /> Owner (Mortga9or) ' �� <br /> Billing Name ' '� <br /> � !^ � + . <br /> , � ��f�,-. , t.�i , ;_� <br /> Connection By , , <br /> I f�/ C. <br /> , � 7 � ,. �� 5 ,.s� •.�r�- _ � ..Iglled Cusromer �. <br /> Address - <br /> . � <br /> . '� ..- " � <br /> Phone <br /> Sewer District <br /> DESCRIPTION: � <br /> Lot Block Monthly Sewer Service � <br /> Plat ,' " <br /> Unplatted Description Monthly Sewer Constr. � <br /> Trunk <br /> Type PermiC Lateral <br /> � — <br /> .�, � <br /> Remarks: Abutting Lot Line ft. <br /> N, S, E, W , <br /> _ l Rl. � � <br /> Approved By ' :I — <br /> Ciry�=n9�neer <br /> � / . <br /> ISSUCd BY . -- � <br /> C- <br /> Inspection B <br /> Date Inspected � �3 �/��� <br /> � <br /> n NO. ' <br /> SEE SKETCH ATTACHED � . <br /> If4 :PL'C I�I!��'�� � <br /> i� � ��' <br /> I "�. "ic�>' ",�°, , _ <br />