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CHART NO.�" ` � <br /> everefl ` . <br /> �. i ! <br /> � i`_D-' �...�„�� � , � <br /> City of Everett �(��l � <br /> Engineering & Community Services ����'�� j <br /> i <br /> Sewer Application and Permit � <br /> ; ; � , <br /> , , ; <br /> ;` ;j,; ;i,. _ � <br /> NO. � �' � :� ij DATE _> i <br /> �' � `�- . '../-- o� 1 <br /> Service Address <br /> ��, i} 0�1 f� •/ � . ;,;.i• /� -1' Utility Account No. 1 � <br /> " " •Permit Fee 3 U � <br /> BillingAddress� �U� �I• �;'�� -- , ' .: y { <br /> /� ,%��'� � �j,- . /yD >J Connectiun Charge(s) �� S <br /> City, State, Zip � � ` � <br /> , ' = <br /> �/� �r : �.. ' i " Total Fee_ i �, <br /> Owner (Mortgagor�_ ' <br /> , ' � <br /> Billing Name ``"� " �� <br /> �_., _ . ' <br /> Connection By • . ,��� <br /> Signed /r .�,.� , � .� <br /> Address -- c�:�onmr , � <br /> " - ! i � �/ 1 <br /> Phone�— �J /� � � <br /> /i�. :• f <br /> Sewer District � / JY, <br /> DESCRIPTIOfJ: j ; / <br /> �. GM./ / . �'l"i�:i. 'I <br /> Lot � Block �` � ' —� Monthly Sewer Service_ ' ! <br /> , � —� � <br /> Plat �. � ' ' <br /> Unplatted Description Monthly Sewer Constr. <br /> ,: 7 .- -<D.0 0 <br /> Trunk ^ ' � <br /> Type Permit: ;,� � � • ' L' �i, j �'( ;.oa <br /> Lateral I <br /> Remarks: Abuttin� Lot,L-jne �p <br /> N, S(�.E'; W ft. <br /> �--- - <br /> ApprovedBy• ��`"�' � <br /> City Engineer � <br /> Issued BY � " `�'� �r <br /> 1 <br /> -- ! <br /> Inspectio� By � " <br /> Date I nspecte L/v ^ �3 ��'� { <br /> i <br /> � N0. � <br /> SEESKETCH ATTACHED � <br /> ��! ; , J <br /> s{. <br /> F�.. . �"-4�:�,: t{'�''.;'_�x"�, .:.., h - .�..d:� . . _. . . . . <br />