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CHART NU. "�* �'- '� ' <br /> a, . <br /> everett %t. <br /> �3. <br /> � `. ; 7 . <br /> . t I,µ� <br /> • r jr, <br /> City of Everett . . <br /> Engineering & Community Services <br /> Sewer Appiication and Permit :; <br /> ; - �, � ��. � <br /> No. ?2566 'r ' <br />, <br /> DATE <br /> f <br /> � <br /> r SerdiceAddress 'r�v1 `���'-/ �— UtilityAccountNo.='� G '� '`�� ��� <br /> / �- � ,� .::-- <br />, . ' Billing Address ��'� �- �r � `' { Permit Fee ! <br /> ; . � ,,^, <=,..-- <br /> City, State, Zip - - / ��� • � � G'-1 Connection Charge(s) `��"" � <br /> :r% i <br /> Owner (Mortgagor) - �� l / : Tctal Fee <br /> � / <br />� Billing Name ' -�' - - ��' <br /> .�" � <br /> Co�nection By_ `"' � � <br /> Signed �' % . _, , ` /; __:...-..�i <br /> Address c„s, tr <br /> i ' � � - � �/�� <br /> i Phone - `:� <br /> <� . � -� <br />�� DESCRIPTION: Sewer District <br /> I� Lot ` � , Block Monthly Sewer Service 's � <br />� Plat ._;• ,� , , � ,- - � .� <br />, Unplatted Description ` � � �- -�� Monthiy Sewer Constr. <br /> — Trunk ' ' � �� / �'� � ��� <br /> Type Permit: .'i - ` - � <br />, Lateral . `,� �/(. nv <br /> Remarks: _ Abuttin Lot,.L'fPte <br /> N, S' E;-j�y �v ft. <br /> — <br /> �. <br /> _ ------_ _ _ <br /> _ . APProved By _ '- * <br /> .Ciry Enginccr <br /> Issued By ' --- - � <br /> - - Inspection By - <br /> Datelnspected <br /> n SEE SKETCH ATTACHED No. 2 2 5 6 6 <br /> INSPECTI�N <br /> t <br />