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everett CHART NO.� •l� � T � <br /> i <br /> � ` �� ' <br /> ��%`.j/ � <br /> � �� - � n._ 7 �-,� I <br /> � <br /> City of Everett 1 : <br /> Engineering F� Community Services ' �/��t'�� /� � <br /> `, I <br /> Sewer Application and Permit '' � ! <br /> . ; <br /> _ , <br /> N0. F' [` J !� .L DATE (' / �'. <br /> { <br /> � <br /> �'� '� G �'!_i',r��i ' <br /> Service Address � ' �'' `-•% Utility Account No. <br /> Billin; Address�� �l d R��- �%Q � <br /> Permit Fee ' <br /> _ i <br /> City, State, Zip'���/< k-! ��n.i�� ((.�d . '.-' ( � � Connection Charge(s� ' <br /> Owner (Mortgagor�r�'�' �v � � l /i i �/ r Total Fee � <br /> Billing Name �.�%����i� � <br /> , <br /> � <br /> Conneciion By <�--� � r.'� - j <br /> — �G" . t���C�l'T I <br /> Address SignedC.�-C-./G- �JIILJJ��I/'1�J � <br /> Customer — - <br /> Phone <br /> DESCRIPTION: ! <br /> Sewer District ; <br /> Lot Block -- ; <br /> Plat Monthly Sewer Service <br /> Unplatted Descrip[ionV.�. F-�L- t ` �/' �i F ' � <br /> � G � Monthly Sewer Constr. <br /> _ I <br /> Type Permit: ,�/L ;� , � ,... Tnmk � <br /> + L-�Li1 L � <br /> Lateral { <br /> Remarks: : / L / .,L <br /> � -l.C-c ' if l��r- [�' �_A,c-LGc � <br /> � � Abutting Lot L�ne <br /> yz _� r� s, �? ,- ; <br /> /+ 4-�- N, S, E, W ft. � <br /> —E��'t�,r• / � /�7i �..r� <br /> —J�-2.�i (t r 1..]� �l..0. � <br /> APProved By L ��G.-.(�<Ji ,�-(y � <br /> Gry Engmcer � <br /> / / <br /> Issued By !' � i �L-G t/1ir r✓ ' <br /> �/ - �n/ /� I <br /> Inspection By �-�.f'�Y"y�.s-L j <br /> a Date4nspected �i — �- 7D <br /> SEESKETCH ATTACHED � <br /> IPlSFLCTICii! NO. , ._ <br /> ���3;='�, ,� <br />