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CHART N0. �' ���Z` �� ' <br /> � everett � <br /> � � ✓, � �- ��' <br /> � e <br /> 1 City of Everett <br /> � Engineering & Community Services ' <br /> � Sewer Applic�ati�n �and Perrnit <br /> � <br /> � N0. � f i 0 .�. DATE -5 ` �' 7'7 I <br /> Service Address � �� �' '� � �����'• Utility Acccunt No. <br /> Billing Address Permit Fee_ = <br /> ,� j / <br /> City, State, Zip ^Kr`-r`���/Y,�:b�L. y S 1"d � Connection Charge(s) <br /> .y]�i..,_ /-=je../...r'. .; � ..�.. :if-'�"'t�}: :i"e.7 <br /> Owner (Mortgagor���'���_� ���•� � F�% � ��_'��✓'��otai Fee � f <br /> Billing Name_ . <br /> � r r <br /> l ] �' <br /> Connection By �'r�"�"�' �,��'��` � i . .' <br /> r, f,i. <br /> . � <br /> Address % 7/Z: �R�..�c; Signed. `'°,s� �.:..s. ,.-�j�+'�%�- <br /> Y <br /> CJ omer <br /> Phone ? s �' ` 5 /`� 7� <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description��1 �/�-%" �-� �^� ��•4 � � ����Monthly Sewer Constr. <br /> �1�; 3/ �3> a�.{ 3 !�!,;..�..`.J�� �'=L�,��'i i...r-.���..,;x <br /> Type Permit: `= ��? "�`j'""�""` �� t Trunk <br /> � �,� � /���� Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> �� Q.t �,� <br /> ,1 r�_ <br /> Jr� � Sv�.ti � i r L1. APProvedBy ✓� -';�i�nn�. <br /> Ciry Engineer �, <br /> re� 7� <br /> — IssuedBy (--' f-G�':�br.�` <br /> inspection By ��""'`'�`-'— _ <br /> y Date Inspected��7 7 ___ <br /> � <br /> SEE SKETCH ATTACHED NO. __ .. <br /> li�'' i � ' I IUi�! � - <br /> �� » _ <,���.. :,--• � 7 ss <br /> , . �� � � _ ' ' ._ � �° � ! � _ `�".` .,.� _ <br /> •.�._ _ <br />