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CHART N0. <br /> CVE'fClt <br /> e <br /> City of Everett <br /> Sev�er Application and Permit � <br /> nH <br /> /' / �7 <br /> N0. 25112 DATE �,C�.3 /�� <br /> �� /�.9 <br /> Service Addres������ //�� '4"" �� Utility Account No. <br /> 0 M N <br /> i,r O� H '*7 <br /> Billi�g Address�lQ� �j� '�" /�:v'E� Permit Fee �� r, y <br /> � � <br /> City,State, Zip �.*,.-c� Z�'�./a- - Connection Chargels) _ � 4�j <br /> 0=� � <br /> Owner �Mortgagor) � Total Fee �� — � <br /> Biliing Name_ � H <br /> � <br /> � � z <br /> Connection By z� <br /> / / , , �' ; H � <br /> Address �/ Signed � i - %�� � � yP �7_ — � � <br /> Customer �� O <br /> Phone ��y -.�/y7 __ "' <br /> DESCRIPTION: Sewer District � vi <br /> Lot Block_ � � <br /> Plat Monthly Sewer Service <br /> � <br /> Unplatted Description Mon[hly Sewer Constr. . � <br /> Trunk I <br /> Type PermiL• � i � <br /> Lateral <br /> Remarks: � � <br /> — Abutting Lot Line i N <br /> N, S, E, W ft. I � <br /> - I � <br /> Approved By-� - G ' ' Lyu� <br /> CitY Engmser i <br /> Issued By � </ 5 r I <br /> I <br /> I <br /> / � � <br /> Inspection [3y �`J(*��' �"�''� <br /> Datelnspected S '�3 -�'f i <br /> Sl:E SKETCH ATTACIIED NO. Z511/� <br /> INSPLCTIOt� �i <br />