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j <br />everett � <br />� <br />City oF Everett <br />Engineering & C�mmunity Services <br />Sc�wer Applic�tio� and �erimit <br />DATE �" ' <br />NO. Ll �J�% � — <br />Service Address <br />/ /o l �`�`� i <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) — <br />CHART N0 �^� �r_'� <br />�� � I <br />� � � <br />�i <br />�� �� � �7 � <br />���' <br />Utility Account No. <br />Permrt f-ee � � ' � --'—' <br />Connection Chargels) — <br />Total Fee -'"-' <br />Billing Name <br />. � . <br />� i <br />Connection By - "��' � i <br />I / , /l � <br />Address l Signed <br />Custamer � <br />DESCRIPTION: <br />�o� Block <br />Plat <br />Unplatted Description_ <br />Tvoe PermiL• ..� � — <br />Sewer District <br />Monthly Sewer :iervice. <br />Monthly Sewer Constr. <br />Trunk.__ <br />Lateral_ <br />Abutting Lot Line <br />fV, S, E, W_ <br />SEE SKETCH ATTACHED <br />��i�,ri.,�;-i,���� <br />„ �. s � <br />F��'�� � �li!'�i��':'iu, ,Y�.� � <br />y f .lG�Y d 1�.,� `.. _ <br />,, <br />Auproved By . ' � ' <br />City Engineer , <br />! �. <br />lssued By - _— <br />"'�!�%ilrt.:..t<�,Yf" � <br />Inspection By � <br />i <br />Datelnspected �� l 1 " 7� <br />, <br />NO. . <br />�e'��`�-t"� , ,� :�4`•� �.:as.. ' <br />