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�so�! .. ..... .._ . .....,.__���} .._.__��. �. <br /> e��erett CHART NO..��� �� <br /> , <br /> � ! �'� ` �- �� � <br /> �"�/ i � <br /> ��♦.`/�� ) ..�. 1 <br /> Y `^ � %' •� I <br /> City of Everett �� � <br /> Engineering & Community Services � r i <br /> � <br /> Sewer Applic�tion anc� Perrnit � ; <br /> N0. _ : �.i .:. '..; DATE G ' �'C - 7ri <br /> Service Address J .� : `" � Utility Account No._ � � � / `� ' <br /> c� <br />/ Billing Address ' ' '! i Permit Fee Jv �' <br /> ^'r <br /> City, State, Zip � /-_,� Connection Charge(s) -- �- �} <br /> ; ,� <br /> Owner (Mortgagor� _ ' ' Total Fee i =' � ' <br /> I <br /> billing Name �-- <br />' Connection By <br /> Address Signed_ <br />' Cw�om�r <br />, Phone � �' � ; <br /> I DESCRIPTION: Sewer District � �� <br />� Lot � i:" Block -1 , _ <br /> I �/ /� Monthly Sewer Service � 5 J <br /> Plat � i,�-� �c-C--�—c�. � ��`--- <br />�, Unplatted Description _ Monthly Sewer Constr. <br /> � ' <br /> Type Permit: Trunk ' ' - <br /> Lateral <br /> Rema:ks: ' <br /> — Abuiting Lot Line <br /> — h, S, E, W ft. <br /> i <br /> Approved By ' :%'� � <br /> — Ciry Enginccr , <br /> i � <br /> Issued By - - _� i <br /> I <br /> _ Inspection � � � C •�C� _ i <br /> --- -- Date Inspected� av � �� i <br /> .. --T <br /> SEE SI<ETCH ATTACHED Np, i <br /> .: _. _._ _____ _ ' , <br /> . _ _ _ _._. ----- _- �--_. __ <br /> _ _.,.... � <br /> 7 <br />