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��� <br /> � <br /> CHART NO. ��' " <br /> everett <br /> � �� � � � <br /> _�� r< c> �� - '�- '> � <br /> - � , <br /> � <br /> City of Everett <br /> Severer Application and Permif <br /> ,� <br /> N0. Zsf1O6 DATE _, ��'� �� ---- — <br /> / I <br /> Service Address�� i7 �' �� � �` Utility Account No. <br /> ��._� <br /> i <br /> BillingAddress�A�'�"A' PermitFee ''U - <br /> 0 <br /> City, State, Zip f�� -�a� ����v� Connection Chargels! . <br /> � .� ,v .�, <br /> Owner (Mortgagor���-'•� � � Total Fee <br /> Billing Name �-� '"+�1 I <br /> Connection By��-+ 't�Z!� � " '���'"r� � <br /> Address � �z" � ��/� Signed c�:�om�• � <br /> Phone 7 3�/ � Z"�'/ � <br /> DESCRIPTION� Sewer District <br /> Lot Block— Manrhly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> � <br /> Remarks: Abutting Lot Line I <br /> C_ N S E W ft. I <br /> i <br /> � <br /> I <br /> Approved By �I <br /> Cit Engineer <br /> �' ,���� �I <br /> — Issued By � <br /> - I� <br /> t � � <br /> Inspection P,y I <br /> � <br /> Date I nspected �/ � � ' � <br /> SEE SKETCH ATTACHED N0. ZQ1O6 <br /> � <br /> INS'"rt`CTION I <br />� <br />