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everett <br /> � ,' <br /> City of Everett <br /> Engineering Department <br /> Sew�er Application and Permit <br /> N0. DATE —_-- -- — <br /> Service Address_ Utifity Account No._ <br /> Billing Address Connection Permit Fee -- <br /> City, State, Zip Connection Fee_ — <br /> Owner (Mortgagorl_ Total Fee____ _ — <br /> Billing Name —. <br /> Connection By_ — <br /> Addres Signed _— <br /> Cusromer <br /> Phone_ <br />� DESCRIPTION: Sewer District_ _ _ <br /> Lot <br /> Monthly Sewer Service <br /> Ellock __ <br />• Division or Addition Monthly Sewer Constr. <br /> -- Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lat Line <br /> �� S E, W — ft. <br /> ✓R �Cu-e,d� r ; � ��,i (.0 �� � �Yw�l' i <br /> l <br /> �/ r <br /> (� � .4Clil / <` <br /> Approved By_ —_— <br /> Cily Enpineer <br /> '�e '��� Issued By <br /> Inspection By �`�,'~r-�`{"'�---_— <br /> _ ____._ Date Inspected �/7�� 7 __ <br /> o- -- <br /> SEE SKETCH ATTACHED N� ^ 1 r r� <br />