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� <br /> � <br /> ; <br /> � <br /> 1, <br /> i n <br /> ! everett CHART N0.11—� ��2 �= �'� <br /> , � _ <br /> � _._ <br /> � .i y) <br /> i, \ �" <br /> ' City of Everett Co - ,� ' <br /> � Engineering & Community Services ' <br /> r�, <br /> �,....� `� . <br /> � Sewer Ap,plication and Perrnit <br /> i <br /> " N0. ,' ; ' DATE <br /> i —� — <br /> � Service Address � � `�� ' �` � ,' /�;� �.., L .� 1 , <br /> Utility Account No. <br /> I Billing Address � l � ' � �� `� 1 '�( <br /> I Permit Fee - <br /> � City, State, Zip � ( (' Y�L lli+ i .' / �� ', Connection Charge(s) �- `- ` ` ` <br /> � Owner (Mortgagar) .!I�L.t�>/- ;l� : l�-'�r c.;;;,�,, �. Total Fee <br /> i — <br /> Billing Name i 1 �-. �;_, <br /> f � <br /> i: <br /> j Connection By _ �'� , ,_�_� <br /> � � <br /> ' Address ' <br /> i _ Signed - <br /> �: <br /> �' / [/// Customer <br /> � Phone— .�.� 3- / T - <br /> � DESCR!PTION: <br /> , Lot � Sewer D�strict � ' : > !L1 <br /> I Block <br /> � Plat � c. . c ;; -: , , . , ,, /.Ci <br /> . , . Monthly Sewe� �ervice <br /> I Unplatted Description Monthiy Sewer Constr. <br /> � Type Permit: ' it:. ,.. � — Trunk =: , ` <br /> � - c .<_ <. . ��: — . <br /> Lateral <br /> I! Remarks: --- <br /> I Abutting Lot Line <br /> � N, S, E, W ft. <br /> i <br /> I <br /> � <br /> I , I <br /> APProved By ' � '�- �- <br /> ' _, Ciry Engmeer <br /> i — <br /> i <br /> � - Issued By ' � -:�- - / <br /> I ' ' - <br /> I <br /> i <br /> � Inspection By '� O..r �^ . <br /> s Date Inspected�.3�� � "s <br /> S[E SKETCH ATTACHED N0. <br /> { • I�VSPECT����I ,��, _ " . . <br /> � `'Qsa� .__. . . � � ',. ... � :. ` �>.�..wA� _ . . _ ". <br /> r <br />