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:�,._ <br /> CHART N0.— <br /> evereri <br /> � . <br /> City of Everett �!�' �1Z�Il�}/,?C/- �/r� <br /> Se./� 7c� C.harfi�4 <br /> Sewer Applica�ion and Peranit 8/z��b <br /> N0. Z�iJ$Z DATE ��(��� � <br /> 1 <br /> Service Address � ' � ' - ' ' ` �-' `---� Utility Account No. <br /> Biliing Address J� -' �/ J' ' ' r ' '— Permit Fee • <br /> j . � <br /> , <br /> City, State, Zip '� � �' ' - � �' ���11 ��� " Cc�nection Charge(s) -- � — <br /> � <br /> r i + ; .� "_ <br /> Owner (Mortgagor! � ' �" � ' �-: ' - Total Fee �-' ' _ <br /> _ �� ( ' . / i <br /> BillingName ' �� ' ��" , ; : / _� �. ' �� <br /> f — <br /> i <br /> � <br /> Connection By �i <br /> � ! <br /> Signetl , � ` - , 1 ,t:-2 ,�.,�._ _ <br /> Address cu:�on,er <br /> Phone '� � - � � 'J ' l �---- <br /> DESCRIPTIO : Sewer District i�" <br /> Lot ' Block� Monthly Sewer Service -- - <br /> : ; <br /> Plat � — <br /> Unplatted Description Monthly Sewer Constr. <br /> ' _�— <br /> Trunk - <br /> Type Permit: �'���'_.- <br /> � s Lateral <br /> Remarks: � Abutting Lot Line <br /> N, S, E, W ft. <br /> ..2, <br /> ,4/ g�53�_ <br /> ; "_. / r, � <br /> Approved By %, <br /> Ciry Engineer <br /> IMPORTANT! �„ ,,,,. . - <br /> Issued B y <br /> CA L L 1�800�424•5555 48•HOU RS �� <br /> PRIOR TO DIGGING <br /> CALL 259•8871 FOR INSPECTION . <br /> Inspection By � ^^��� <br /> Date Inspected�' <br /> SEE SKETCH ATTACHED No. 25582 <br /> INSPcCTION <br />