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i <br />� <br /> I� <br /> � everett cH,aRT tvo. G�*-�[Q���> �" <br /> � - <br />� i � % '�'`� <br /> i � , . <br />. , �,� _ �_�f <br />! City of Everett <br />� I Engineering & Community Services �/� <br /> � �'� <br /> ' Sewer Application and Permit <br /> � <br /> i rvo. "' ;� �� �� : :� � ' <br /> _ ,_ . . DATE I ' <br /> I ----*— <br /> 4 i � — <br /> Service Address � %�- _ �` <br /> Uti�ity A�count No. � ' �-�� . , <br /> � Billing Address � � - , ' � � i <br /> � Permit Fe,_ ` <br /> � CiYY. Statc, Zip � �i' r,' L.i i' :' I L : <br /> I "' Connection Charge�sl_ =_' ' � <br /> iOwner (Mortgagorl "-, � ;` : ;� � , --- <br /> ; Total Fee <br /> IBilling Name__ ,':_�.:,� — <br /> I Connection Ry�,..-�_.r - �. <br /> ,_�—_---_—'-- <br /> � <br /> ' Addiess <br /> � —_ Signed <br /> � 3�' � <br /> � Phone_ � - j Jy� ' Lustomcr <br /> IDESCRIPTION: <br /> � ��t � Biock Sewer District � :_! <br /> iP�a= � - Monthly Sewer Service '�� `- �-. <br /> I Unplatted Description <br /> _Monthly Sew•er Constr. <br /> I <br /> � TYPe Permit: �_ i —�'—' Trunk <br /> ; �` <br /> '- " � _ ,. <br /> � Remarks: <br /> Lateral <br /> Abutting Lot Line <br /> i -- <br /> N, S, E, W_— ft. <br /> I --- <br /> � <br /> i — <br /> j —--- <br /> � , Approved By <br /> , <br /> � City Engincer ' <br /> i <br /> Issued By � � � <br /> f <br /> i <br /> i - <br /> � — Inspection By � c �,-�:_,__,,,_, <br /> j3 - Datelnspected_ �/3�/7,? ' <br /> ; <br /> SEE SKETCH ATTACHED <br /> -�� ` I 1SPGC;IIn � N0. <br /> � y. � _w�'s.. . _._. , �`tii � .' ';,1�� � ._��,.. , r � � <br /> .. � 35���;:�: <br /> I <br /> � <br />