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�--�- <br /> CHART N0. 1��'� � '� � ` �'I <br /> everett <br /> ���� <br /> � �:�� <br /> � r_.� -�/�,. <br /> City of Everett <br /> Sewer Application ar�d Perrr�it <br /> NO. Z�QS3 DATE ; ,c�t <br /> Service Address���`- ���ti—�0�'/�' fC� Utility Account No. <br /> Eiilling Address �' �� � Permit Fee - � <br /> City, State, Zip Connection Charge�s) <br /> Owner (Mortgagor) / Total Fee <br /> Billing Name � ' '- <br /> Connection By <br /> I <br /> Address Signed � � <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot_ Block Monthly Se�Ner Service <br /> Plac <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: � <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N• S• E� W — --ft. <br /> /L�0 1 �v S ��c_—,u r�1 <br /> � �,1 <br /> - Approved By <br /> �U - L� —�� CiryEn9ineer <br /> Issued By �' <br /> i <br /> Inspection By — <br /> __ _ _ Date Inspected <br />� SEE SKETCH ATTACHED No. 23083 <br /> I'NSP[CTIOf�I <br />