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� <br /> � i� .��Q°�� •�, � <br /> CHART NO.�'" � �' '� � � <br /> everett �ss ��� � <br /> � I <br /> City oF Everetr <br /> Engineering & Community Services <br /> ' Sevwer �4pplication and Permit <br /> i N0. �' n� I-, °J DATE ' i� � j �,; . � <br /> i <br /> Service Address ' �`� ° Utility Account fJo. ` <br /> , � <br /> Billing Address ' ' ' � Permit Fee <br /> City, State, Zip ^ F '� � _ Connection Charge(s) % 'i r r ,' ��_ <br /> j O�vner (Mortgagor) `-" ` •� ' " � !�� ' �. Total Fee_ , <br /> , Billing Name ,< ,' i .�;. i L� , , .; <br /> Connection By " <br /> � . <br /> �,- , ' , <br /> ,�/ ;- <br /> Address - � � Signed '-T �!'� %'��• '�;" _ <br /> Q¢mmer <br /> . � _ l, ' ._ (�. / <br /> Phone� - - <br /> � �T;-- <br /> ' DESCRIPTION: Sewer District ` ' ' ' ` —_ <br /> Lot Blcck , �-�- ' <br /> Plat C. r,. ''' Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk ` <br /> Type Permit: - � , ,.i� . <br /> ; Lateral <br /> ' Remarks: <br /> -- Abutting Lot Line <br /> N, S, E, W __ _ft. <br /> I <br /> � Approved By ` ' <br /> Ciry Englneer <br /> �� � %.1:, L/itJ -Al�../ <br /> ; Issued By - _ <br /> � 1 <br /> Inspection By.��—_��— <br /> Date I nspected "iQ�j���_�_ <br /> o ' � - <br /> �E SKETCH ATTACHE� N0. <br /> ; <br /> — — _.. __._ . . . _-_ <br /> �„� _ <br /> .�r;�, _ � fi .w�i,--r-.-=------- - I <br /> .:. .. �- �_..,r:. .. . <br /> i <br /> i <br /> i <br /> � <br />