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evereK ' ' <br /> i ( 1 <br /> � � � /7 /� a/� � . <br /> , r <br /> � , !` <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit :�.3r�t;4 <br /> NO. � O 7 1. 7 DATE — - <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee, - <br /> City,State, 2ip_ Connection Fee <br /> Owner (Mortgagor) Total Fee -- <br /> Billing Name <br /> Connection ?•; <br /> Address _ Signed__ <br /> Cus�omer <br /> Phone_ <br /> DESCFIPTION: Sewer Disvict _—_.— — <br /> Lot <br /> Monthly Sewer Service_—_—_— <br /> Block <br /> Division or Addition _—__ _ Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral _ <br /> Remarks: <br /> Abutting Lot Line <br /> � N. S, E. W------ it. <br /> I <br /> Approved By — <br /> Gty Engmrer <br /> Issued BY---- -------- <br /> l <br /> Inspectior BY= _�� �''��--�`—�-'- — <br /> a— -- ------ — <br /> __ Date I nspected�1��'� �---- <br /> SEE SKETCH ATTACHED NC�. <br />