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' CHART I10. i <br /> i everett � <br />' � . . �, <br /> �. �� ' <br />' I i:,'i� <br /> City of Everett � ` <br /> I: <br /> Sewer App►lication cnd Permit � ( ' � �' <br /> NO. ZQ.��� DATE , „ � — II <br /> Utility Account No. — � <br /> Service Address�� ., , i <br /> BillingAddress ��+ z �«l� ��;;-z�----- PermitFee � , � <br /> � <br /> City, State, Zip • Connection Charge(s) I <br /> Total Fee I <br /> Owner (Mortgagor) v a - �a'+as-�,..�.y-- � • <br /> I <br /> Billing Name , � <br /> � <br /> Connection By — � <br /> I <br /> Address �� Signed --- �i <br /> Customcr I <br /> I <br /> Phone ecn_�.,, <br /> -• I <br /> DESCRIPTION: Sawer District i <br /> I <br /> Lot Block�— Monthly Sewer Service <br /> Plat �re5 T I <br /> I Unplatted Description : �—Monthly Sewer Constr. i <br /> F of allevY Trw�k I <br /> Type Permit: I <br /> � Lateral _._ � <br /> IRemarks: Abutting Lot Line � <br /> N, S, E, W --- ft. �i <br /> !�/5 ' <br /> �,Ja� - , <br /> I ��� Approved By��— I <br /> I E i <br /> Issued By c rr• , <br /> 3�-f <br /> � <br /> i <br /> Inspection By ! <br /> Date I nspected , <br /> No. 2lt485 � <br /> SEE SKETCH ATTACFiED � <br /> INSPECTION �I I <br /> ,_ � <br /> � <br />