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CHART NO.- <br /> - -- _ . __.�.... i <br /> everetl � �S - ` %- / � <br /> � ��s�� � <br /> ; <br /> City of Everett 7 � ��" �� I <br /> � Engineering & Community Service, G <br /> Sewer A�plication and Permit ; <br /> �- <br /> � ; <br /> ; <br /> N0. �' `�' ;) !� Gi UATE <br /> 1 <br /> I <br /> Service P.ddress � � �tilizy Account No. � ' `� � ' � `- ' ': <br /> � <br /> Billing Addre,s � �- � ' ^ ' Permit Fee _ — i <br /> � <br /> City, State, Zip ' ' - Connection Charge�s) � / ' � _ ! <br /> i <br /> Owner (Mortgagor) __ Total Fee �: <br /> I <br /> Billing Name ^ ^ " ! <br /> { <br /> Connection By � / I <br /> i <br /> Address _ � . Signed � 'I"'.�/ !�Z(''k^—_' ! _ <br /> . � _ Custemcr � <br /> Phone �" " <br /> I <br /> DESCRIPTION: Sewer pist�ict ', <br /> Lot Block _ � <br /> Monthly Sewer Service_ " i <br /> Plat _ .� . - _ _ i <br /> Unplatted Description Monthly Sewer Constr. � <br /> — Trunk <br /> Type Permit: i <br /> � Lateral ' <br /> � � <br /> Remarks: � <br /> Abutting Lot Line � <br /> N, S, E, W ft. i <br /> I <br /> � <br /> Approved By ,•- + i <br /> Cily En�iineet ,�' � <br /> I <br /> Issued By 'v � <br /> 1 <br /> � <br /> � i <br /> Inspection 8 . � <br /> �/��� � <br /> 3 Datelnspected__�\�%� ' II <br /> SEESKETCH ATTACHED NO. � <br /> ii�!'?t I:�C1�IOi�I �� i <br /> I <br /> � <br /> � <br /> i <br /> ..�_. -.. . _ ._.. <br />