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e�erett <br /> CHART NO. � = ��� -��' '� <br /> �i y. �-� � . <br /> � ! <br /> City of Everett � ��� � `-�� <br /> � � `� <br /> Sewer Application and Permit <br /> �:% <br /> N0. Z��SQ DATE _'t'� : / ` <br /> r <br /> Service Address_ i� :' � ' ' Utility Account No. � / � <br /> Billing Address I � r i � r . � � � � i Permit Fee � � <br /> t <br /> City, State, Zip � �: ; ��c, -.:� ( � ," + ( Connection Charge�s) � I� <br /> Owner (Mc�igagor) Total Fee � � <br /> Billing Name'' � ' <br /> Connection By ' j <br /> Address ' j � � Signed , � � � <br /> , <br /> {�hOf18 '-1' i ; - � . .� � � . � Cus�omer � 'i <br /> DESCRIP?ION: Sewer District <br /> Lot Block - <br /> Plat Monthly Sewer Service <br /> Unplatted Description � j ! �: Monthly Sewer Constr. <br /> , - ,1 <br /> Type Permit: , _ . Trunk <br /> Lateral <br /> Hemarks: <br /> � Abutting Lot Line <br /> ��'�� � - "�Z: c- / r , .�¢ C'� fV, S, E. W <br /> ft. <br /> 7 �.��'' '� - -' Lz cr //r�i LU <br />' � L7t�-. _., e=G� .� r ��v /� .-e <br /> _ TizvN�-F-f�.�r: "` / y•- g <br /> Approved By <br /> Ciry En�inccr <br /> Issued By • <br /> �� �� <br /> Inspection By ���l/ z i/� <___._ <br /> -- ---- Datelnspected � Z�� -- ���� <br /> SEE SKETCH ATTACHED N0. 23�{J� <br />, IIJSI'i:�71UN <br />