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� CHART N0�3������ <br /> everett <br /> e ,� sT� o <br /> /- 23 - 7S` <br /> City of Everett <br /> Engineering & Community Services ���� <br /> Sewer Application and Permit <br /> � <br /> NO. 1 :� �� _�_ ���I DATE �� " - �' % r' � . <br /> Service Address— `� '� ,�J���G f'/!.:• Utility Account No. _ <br /> Billing Address ^� ��• -- � y� �� Permit Fee - '� <br /> City, State, Zip -^ ' �`* �C�P --�L � i��� �' i'v'� Connection Charge�s) "` �` <br /> Owner (Mortgagor) %" � - � 7otal Fee -� '� <br /> tliliing Name -�---- / / <br /> /' <br /> Connection By .•-.:._- ( / � ��% <br /> Address Signed� <!�� / j" <br /> / Customer <br /> Phone � % � - �/_� '� <br /> DESCRIPTION: r -�' SewerDistrict_ -- -----=—�- <br /> Lot -� - Block - - Monthly Sewer Servicz =' '-� <br /> Plat " <br /> Unplatted Description Nlonthly Sewer Constr. <br /> Trunk_ <br /> Type Permit: �,_ - <br /> Lateral <br /> Remarks: <br /> Abutting Lot line <br /> N, S, E, W ft. <br /> � — Approved By ';� <br /> Ciry Engincer <br /> i � <br /> ISSUCC BY�__ _ / <br /> f <br /> � Inspection By ��ii':e2-�L- <br /> i — <br /> � Date Inspected /fi3� 8' '"' <br /> 9 � <br /> SEESKETCH ATTkCHED N0. <br /> iNSI'i:CTi(_���; <br /> � . <br />