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everett <br /> � t ' <br /> L-. - � c _ - L �� <br /> City of Everett <br /> Enpineering Department <br /> Sew�r Application and Permit <br /> NO. DATE L <br /> Service Address <br /> Utility Account No._ <br /> Billing Address <br /> Connection Permit Fee <br /> City, State, Zip <br /> Connection Fee <br /> Owner (Mortgagor�_ <br /> Total Fee_ <br /> Billing Name — <br /> Connection By <br /> Address <br /> _ Signed <br /> Phone Cusmmer <br /> DESCRIPTION: <br /> Lot Sewer District <br /> Bloc Monthly Sewer Service_ <br /> Division or Addition <br /> Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Remarks: Lateral <br /> _ Abutting Lot Line <br /> N. S, E, W _ft. <br /> Approved By <br /> Cily Enpineer <br /> Issued By <br /> Inspection By <br /> � Date Inspected_ • <br /> SEFSKETCH ATTACHED <br /> NO. <br />