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^ \ <br /> C �� <br /> everrl� � ' Z 1 �—' � �f - <br /> � ��� <br /> � � ,.. .� ��� /���. <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> . . �, i., <br /> N0. �' U f� �- �� DATE -- <br /> U[ility Account No. <br /> Service Address! . <br /> Connection Permit Fee — <br /> Billiny Address_ ------ <br /> City, State, Zip <br /> Connection Fee <br /> pwner IMortgagor) <br /> Total Fee_—_ <br /> Billing Name <br /> Connection By_ <br /> Sign�d — <br /> AddfC55 — . Customcr <br /> Phone_----- ----- <br /> Sewer District --- — <br /> DESCRIPTION: <br /> Lot_ Monthly Sewer Sr.rvice_ ----- <br /> Block <br /> Monthly Sewer Coi r'tr. <br /> Division or Addiiion_ <br /> T�unk <br /> Type Permit; <br /> __ Latera! — <br /> Remarks: ___ Abutting Lot Line <br /> N, S, -, W --tt. <br /> Q--- -� Q n �, '��./ ..u�n.'�i(__--- <br /> .�-- py�`."y <br /> lY — <br /> /i <br /> .t�it�x..—.2E���-- APProved By Ciry EnBineer --' <br /> (?�J���Gc1'f _��1�.—� c","'-`�" Issued Bv — <br /> �__�,d.�..� — /�z�P3�- <br /> -- Inspec[ion By.—. , — --- <br /> i , <br /> --- --------- - __�Datelnspected__�U�� ----- <br /> � ----- — — — --- N 0. <br /> SEE SKETCFI ATTACHED <br />