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CHART NO. f��— �y— 7J <br /> everett <br /> � �DS��� <br /> j �i �3 � Q - � <br /> � � � <br /> I City of Everett �� �I <br /> I I <br /> �; Sewer Application and Permit j <br /> ; <br /> i NO. G2961 DATE � ,'�; — I <br /> Service Address ' ' _ i Utility Account No. <br /> .�r I <br /> I � �/ Permit Fee_ <br /> � gilling Address � <br /> I � /, , _ � � Connection Chargels) — <br /> City, State, Zip �� <br /> � Owner (Mortgagory % � �' Total Fee_ � <br /> i <br /> Billino Name � <br /> 'i i <br /> � Connection By -- I <br /> Address Signed --- I <br /> � Customer <br /> �� Phone_ — <br /> � <br /> DESCRIPTION: Sewer District_ � <br /> II Lot Block.J � � <br /> Monthly Sewer Service � <br /> j Plat <br /> I Unplatted Description Monthly Sewer Constr. ; <br /> I <br /> ` Trunk ! <br /> Type Permit: <br /> Lateral I <br /> Remarks: I' <br /> Abutting Lot Line <br /> N, S, E. W ft. <br /> i <br /> � Approved By � �� <br /> City Engmeer <br /> /, <br /> Issued By — L <br /> — Inspection By <br /> � � � <br /> I� �Dare I nspected_s.,��'—�� " <br /> � SEC SKETCH ATTACHED N�• 229U1 <br />