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CHART NO. <br /> evereri <br /> e <br /> Cit�v of Everett <br /> Sewer Application and Permit <br /> N0. 2�1 1 Z DATE f ( <br /> � <br /> Service Address � � � �� - - Utility Account No. <br /> ' Permit Fee r-� ` �' <br /> Billing Address� ' ' ' ' — <br /> City,State, Zip• -- � Connection Chargels) <br /> � '��1, � T_ � <br /> Owner IMortgagor) ' Total Fee <br /> ----• �:J i <br /> Billing Name � . , . - <br /> Connection By <br /> Address� Signed _ <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District �-��— <br /> Lot f Block - Monthly Sewer Service <br /> Plat . �:_ __ �. �... ;� i r ._r. .• � ,. <br /> Unplatted Description iNonthly Sewer Constr. <br /> Trunk `�'�'�! • <br /> t TYPe Permit: �� /Lt r .: ��.i .., , ., . . , :i : <br /> N Lateral <br /> � Remarks: Abutting Lot Line � r <br /> � N S E W f ��.:; ft. <br /> i <br /> 1 <br /> Approved By�' �� � `i�- ' <br /> Ciry Engineer <br /> Issued By <br /> I � _ <br /> v� <br /> Inspection By <br /> ' (1jS . <br /> Date I nspected � <br /> SEE SKETCH ATTACHED NO. Z51TZ <br /> INSPECTION <br /> � <br />