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�/.� C_ < - /-Jv �y <br /> CHART NO `�' -�z / - � <br /> everett • - - - <br /> �' � � <br /> e �=���- . � <br /> :ity of Everett <br /> Engineering & Community Services <br /> S�wer Applicat�o�� an�d P�rmit <br /> IVO. � ,_ ' . _. nnTF __ " � <br /> Service Address_ Utility Account No. - � <br /> Billing Address__ Permit Fee � <br /> i / ::;� _--- <br /> City, State, Zip C�nnection Charge(s)_ <br /> Owner (Mortgagor) Total Fee __ <br /> Billing Name � <br /> Connection By -" '_ ' <br /> Address_ Signed-- -'" �' !�^-''�"~ ` " <br /> Cuswmer . .' i- <br /> Phone_ i %— i�L� '� ' <br /> DESCRIPTION: Sewer District_ % <br /> Lot � Block <br /> Plat � " ` Monthly Se�,ver Service _ <br /> Unplatted Description M��nthly Sewer Con,tr. <br /> — — i runk � �` " .. __ <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Ai�utting Lat Line <br /> '�• S� E� W- - -- ft. <br /> -- Approved By - <br /> Ci:y Enpinccr <br /> ISSUCCJ By <br /> — �1 <br /> — � � ��� ��/ tlL� �' <br /> Inspection 8 - _ <br /> Date Inspected�/ ��� <br /> 9 <br /> SEE SKETCH ATTACHEf) N0. <br />