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i � <br /> CHART NO.�' -�t-�9-:� <br /> everen — <br /> ' ��;. - `�= t� G <br /> : e -� <br /> ; <br /> ; . <br /> M City of Everett <br /> � E�gineering & Community Services <br /> t <br /> fS�wer Application c�r�d P�rmit <br /> � <br /> I N0. F_' 1 :� :� c' OA7E " / l <br /> Service Addrecs_%��� `'� - 1 %,v'• Utility Account No. - ,' �� - - - <br /> Billing Address_ �"" C�• ', o '' � / ;% % Permit Fee -� %' �� <br /> i <br /> � City, State, 7_ip f L! ;! i� J � l;vfJ . i : _ r:�� Connection Charge(s) "�U '�� <br /> 'Jwner (Mortgagor) _�G /�/�' b�//� ;: , Total Fee -� �' ^ <br /> Billing Name --• �� �y �� <br /> Connectio,i By -'� M 1_ <br /> Address Signed ; <br /> Customer <br /> Phone- --' �^ - C l G G <br /> 4 DESCRIPTION: Sewer District_'-' � .� <br /> � Lot � � Block <br /> iPlat -__.. : � _ � .- - - , Monthly Sewer Service • � v <br /> ! Unplatted Description - Monthly Se�ver Constr. <br /> fTYPe Permit: �%'�.,,; , Tr�nk � /:;:- <br /> � ' -� � ------� — <br /> Lateral <br /> f Remarks: <br /> f � Abutting Lot Line <br /> 'r -- N. S, E, W ft. <br /> i -- <br /> � — � <br /> � <br /> i — , <br /> APProved 6y _ -.. ; f ,' � <br /> Crty Engmeer <br /> fIssued By • :- � <br /> 1� <br /> ! <br /> _ Inspection By L�'���' <br /> � _ Datelnspected � �/7 7 <br /> � SEE SKETCH ATTAC;HED N0. <br /> � � -� '�'. , , � �i <br /> i <br /> ;.r_ __ <br />