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1 <br /> N� �' l - t �-- �::. �/ ' , <br /> everett � CHART N0._ /`} �5��I'"� ; <br /> ��5 ��`� , <br /> e : <br /> 6 --�y-�� <br /> City of Everett �l� <br /> Engineering & Community Services "� , <br /> Sewer Application and Permit � <br /> NO. '� .. '� � i � DATE r, I. <br /> Service Address C/� i_�1 i � Utility Account No. % ' - - � '=� � <br /> Billing Address ' � ` � • � Permit Fea_ �'�' �l� � <br /> �� <br /> City, State, Zip _ � Connection Charge(s) � �'% <br /> Owner (Mortgagor�._ --� Total Fee - • �J <br /> Billing Name - <br /> Connection By _ _ < <br /> .'--�,� _ ' /;' � <br /> Address Signed_ '��!,�: :`/ r%. •� . _� i <br /> Customer <br /> Phone - _ �:�. ,/ •::— <br /> DESCRIPTION: SewerDistrict - `-� % /�! <br /> Lot�_, Block _ , <br /> Plat "" ' Monthly Sewer Service ; <br /> , � <br /> Unplatted Description. Monthly Sewer Constr. <br /> Type Permit: _ <br /> � Trunk �• /` �s� <br /> Lateral <br /> Remarks: <br /> — Abutting Lot Line <br /> -- N, S, E. W ft. <br /> - a��- l . ��. <br /> Approved By �!/ <br /> .. Ciry Engineer <br /> Issued By . � � . r <br /> _ . — --- - I <br /> Inspectiort � � � <br /> Gate Inspected �� " �6�_ � <br /> s ' , <br /> SEE SKETCH ATTACHED N� ; ; 'r : , I' <br /> ir; �=r; i;iPl � <br /> �=�; i <br /> � <br /> �' <br /> -w�. <br />