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1 <br /> w <br /> Y � <br /> CHART NO. �' ��'1�'f <br /> everett -' <br /> �o s T�- ;:o <br /> � / _ z�"�- 7 �' . <br /> City of Everett �D� <br /> Engi�eering t1� Community Services <br /> Sewer Application and Permit = : <br /> N0. C � �-' 1' °) $II3 DATE � �1� �S� — <br /> Service Address_ -���� - � %" Utility Account No. > = � ' -'�7- "� <br /> Billing Address �``G� � /�� �� �=-� ' Permit Fee 5nY <br /> �'' � �v'• . � � ��O � <br /> City,State, Zip � , �` '�Connection Chargels) <br /> � ' � / r ,. �' J �y <br /> 0 vner (Mortgagor) ,/�- -'�� / /�--+�`�- � Total Fee � <br /> / <br /> Billing Name_ ' ' ' <br /> Connection By - �- � ---' _ <br /> <_ __.. _-,l. _ ,�,^., . <br /> Address Signed -2--- .+ f1r ! � „���^ <br /> / �' Customer <br /> Phone =l',�'- ��k� <br /> DESCRIPTION: Sewer District�0 ��- �' � <br /> Lot � Block , 3 Monthly Sewer Service ��� '� �� _ <br /> Plat— ,�. � /i <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: � - Trunk �� �� - /o °� <br /> � %- ,s�_ -- _ <br /> Lateral �• r-' % ��✓0 �� <br /> Remarks: <br /> Abutting Lot Line <br /> -- C92lI7'LfiV �/��_ N, S, E, W ft. <br /> Approved By� � <br /> -� ��j � , <br /> Cily Engineer � <br /> Issued By " �' ---"' � <br /> � <br /> i <br /> Inspection By ��� %fl.�K/ <br /> � Date Inspected��_�9��._ <br /> SEESKETCH ATTACHED N0. . <br /> n , <br /> �+., <br />