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II <br /> CHART N0. <br /> everett <br /> e � <br /> City of Everett <br /> Sewer Application and Permit <br /> Z <br /> 0 <br /> NO. Z5O6� DATE �/�/ps� m <br /> Service Address�.Q/ �! �,� �.� vL[-p �,�� Utility Account No. � � <br /> -� � <br /> .�-i <br /> Billing Address Permit Fee �� �� o m <br /> m�City, State, Zip �E'�r.�T,d[ S' Connec;ion Charge�s) <br /> ., �p/ o� <br /> Owner (Mortgagor��• Q- — Total Fee �� —�� _ _� <br /> m <br /> Billing Name ,o Z <br /> c <br /> � r x <br /> Connection By_ / j N <br /> �,"� ,�; -''� / `' -n <br /> Address _ _ Signed % � <br /> � �p <br /> ��� `—���� � Customer� . _ <br /> Phone / 'i� <br /> m.-� <br /> � <br /> DESCRIPTION: SewerDistrict I �r <br /> Lot Block � H <br /> Plat Monthly Sewer Service � � �., <br /> - - --ir <br /> . m <br /> Unplatte:i Description�. Monthly Sewer Constr. A <br /> �---' -� <br /> Type Permit: � /���K� Trunk Z' <br /> _ Lateral � -+ <br /> s <br /> Remarks: � �, <br /> — ' Abutting Lot Line I o <br /> -- - -- N, S. E, W ft. .-". <br /> � <br /> — m <br /> — ------ — APProved By ;� ' I <br /> — --._. _ Ctty Enpmeer I <br /> -- --------- Issued By i� I <br /> — ----- I <br /> - ------ I <br /> _____________ InspectianBy � i <br /> -------_ Date I nspected_�' <br /> �� � <br /> SEE SKETCFi ATTACHED N�• ZSOV� � <br /> INSPECTION i <br /> ,' <br /> � <br /> 1 <br />