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CHART iVO. � <br /> everett <br /> ,�� , -? <br /> , . 7 <br /> City of Fverett .i <br /> [ngincering & Community Services <br /> Se�nrer �4pplication and Perrr�it '; <br /> No. 22600 DATE v ' �� 7 � <br /> Service F�ddress �>� G // !� �%• Utility Account No. -3 ` i�?- i 5;�- � � <br /> r� m <br /> Billing Address ���,3 d 9 �� �f/ ' Permit Fee �� r�/ I <br /> �� p� o�, <br /> City, State, Zip�:/%�-•-�-== rr>. 2G�- , ��Oj.� Connection Charge�s) �d � � <br /> � ! � � <br /> ' � 0 <br /> Owner (Mortgagor) -L�'-�=�' -� �'("�-� Total Fee ��� <br /> Billing Name --!'�-.-��--� � � <br /> Connection By ��-� i <br /> i <br /> Address_ Signed ' � <br /> ' r� w j <br /> ��� - � 7%�' �---_l " � <br /> Phone � <br /> DESCRIPTION: Sewer District 3� �.-�•-�-�- i <br /> Lot���'��� Bloc��k � //� <br /> Plat � ;-:��_,.i.;�/ �/:'�' ' MonihlySewerService ����f'-i-<`�✓ <br /> Unplatted Description _ _ fAonthly Sewer Constr. � <br /> � <br /> Type Permit: �., �,� r`1 -� — Trunk�� � s .��(J �.�-- j <br /> . . _�i..y:�,. ._�. ' <br /> V j <br /> Lateral_���5� ✓ (o S � <br /> Remarks: ! <br /> Abutting Lot Line � <br /> N, S, E, W �� ft. <br /> � , <br /> ./.�..�� . � i <br /> APProved'8y - • �.,-, - , _ I <br /> _ ' Gty Enginecr � <br /> -- Lsued By �J /�� _ I � <br /> Inspection Ey I <br /> _ , <br /> _____ __ _ Date Inspected � <br /> ' ' I <br /> �c_ SK[TCH ATi�`.CHED fd0. �' �, � . ;) J ' <br /> UT!'_ITY EI!.LING _ <br />