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1 <br /> CHART NO.�1`'`�%'' <br /> everett • <br /> i <br /> e �q��� , ; <br /> J�`�/���' <br /> City of Everett . �� � ' <br /> Engineering & Community Services ,� j <br /> � <br /> Sewer Applicction and Permit � <br /> � „ . �.- ,-. <br /> N0. l � .� .� � DATE ' �` .- � <br /> Service Address�'�'� ` 1 �— ^ �Y " ': j" ,'v <br /> Utility Account No. - <br /> d•ir <br /> Billing Address '� - l�� - � Permit Fee ��1 <br /> i <br /> City, State, Zip � Connection Chargefs) S ��`� _ <br /> , �;� <br /> Owner (Mortgagor) � Totul Fee 1�� � <br /> Billing Name <br /> Connection By � ,> , - <br /> 'r� ' � r , '" ��_. <br /> Addres�__ Signed_ i �.!^,�5?J� v'i, / �•,7,.7Yr'-�J� <br /> " ' Cusiomer <br /> Phone_ . - _ - ; ;) <br /> DESCRIPTION: SewerDistrict_: ' � IX � �-�'- <br /> Lot Block �, � <br /> Plat. Mo�thly Sewer Service ' <br /> ,� <br /> Unplatted Description � "� � ` � Monthly Sewer Constr. <br /> /1 �l.� ; /.i ��� , ;i. � r/ . �_ <br /> � Trunk � •�s <br /> Type Permit i ' <br /> Lateral • - � <br /> Remarks: <br /> �butting Lot Line <br /> _ N, S, E, W ft. <br /> � <br /> Approved By • f <br /> Ciry EnBincer <br /> Issued By ' _ � <br /> Inspection By �<«r��"" <br /> Datelnspected� �� —7� <br /> 0 <br /> SEESKETCH ATTACHED NO. � . <br /> �� IP! r iI _, . � <br /> +•- <br />