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� everen cHART N� a <br /> I <br /> Po ��c� <br /> j City of Everett I � I� , <br /> Engineering & Community Services <br /> ; S�wer ,Ap�asicat�on and Permit `� " � " �� <br /> rva �, :-. ; , � % <br /> , , ;� DATL- I����'� /� 7 i <br /> ' Service Address��'?'' /� .i /j �Sj;j' <br /> � �• Utility Account No. � <br /> ! BillingAddress �—%� y-r.. . - ' <br /> —=—_ Permit Fee ---"' <br /> ' City, State, Zip --��:-.�:._:� —^ <br /> ! '. ,"% L-�—;,:: f `;.J Connection Charge(s) <br /> ' Owner (Mortgagor)_ .. / � � ; ��y' <br /> ` ' " , ?otal Fee " <br /> ; Billing Name � �� ,-'I ; . /,.� J <br /> i <br /> � Connection By <br /> � - � <br /> � Address ' <br /> Signed � <br /> - � _ _ <br /> PhOf1P, i -'/ ,��� ��- " Cusromcr- <br /> I � _� <br /> I DESCRIPTION: � � <br /> � Lot��-� � ✓��' Block—;� i D SewerDistrict � <br /> ! Plat ,�� , _��' Monthly Sewer Service `" <br /> Unplatted Description <br /> � Nlonthly Se��er Constr. <br /> � TYPe Permit: '��; , _ ' Trunk J <br /> i - <br /> Remarks: Lateral <br /> Abutting Lot Line <br /> � N, S, E, W ' <br /> — — —:_�ft. <br /> i <br /> I <br /> i Approved By' ��� <br /> ' City Enginner <br /> ISSUQd By=__ � <br /> � <br /> _ Inspection By �ry..�.,� <br /> ' Date Inspected_�2,�/y�'� <br /> ! SEE SI(ETCH ATTACHED —� <br /> ! i —�.';F� ^��,,.n^,,���r-- fISFECIIr��,; NO. ' , <br /> � P <br /> .. . ..�: 1''_,-",'`'�?q�p�,-...-•--�----c:••.,•,,,--- _ <br /> � . .. . i . . . - - <br />