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` ` ___ __ _ _ <br />� <br /> ,, ' <br />, fyf� � CHART NO.������� <br /> � evere� __ _. <br /> I ��. <br /> � � � ~ 1 <br /> 7 � � <br /> f , City of Everett � <br /> I` j Engineering & Community Services <br /> i <br /> i ' S�wer e4pp9ieation and Persnit <br /> � �, ,; �, r � ���_ .. ; i <br /> ; Np, : , , ,� � DATE __ <br /> i Service Address ����' � ��= --✓ ^ - Utility Account No. <br /> i <br /> i <br /> Billing Address � �`' � ' �'` Permit Fee__ <br /> City, State, Zip �� Connection Charge�s)_ ` _ <br /> i , — <br /> � Owner (Mortgagor).'�� � -� � - Total Fee �`' <br /> � Billiny Name <br /> i <br /> t <br /> Connection By - '--� _ <br /> � <br /> ' Address Signed_ <br /> � Customer <br /> � Phone > ; ', - i ��'=� <br /> IDESCRIPT/I�ON: Sewer District -� � - / � <br /> Lot�,_ Block_ - �i <br />� Plat - /-- � i ' d Monthly Sewer Service � <br /> ! Unp�atted Description Monthly Sewer Constr, <br /> � Type Permit: _ . �" . Trunk � - <br /> Lateral <br /> � Remarks: � ' c— f � � <br /> ����� Abu.ting Lot Line <br /> � <br /> � N, S, E, W ft. <br /> � � <br /> � APProved 8y � <br /> � City Enginecr <br /> - Issued By ' ' / <br /> Inspection By r L�'�—�-- <br /> V <br /> Date Inspected C� � � S� — ��� <br /> v <br /> SEE SKETCH ATTACHED N0. _. _ . <br /> , �<��,rC�IlOI�! - <br /> �a .. ,x : .::ka A :,,.h �- . . <br /> k_:�_,_...�._., . �:�;:� .. 1. . _� _ �`! �_ � fi:.x� <br />