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_ _ . <br /> 1 <br /> everett � �� � � ' �L `� - � <br /> e � <br /> �;� ��� Q�Z�/� � ,, <br /> < <br /> Citv of Everett ���� <br /> Engineering Oepartment �n � <br /> F <br /> Sewer Application and Permit , , �, <br /> � �� �:a <br /> �� { <br /> rvo. 2U96 � DATE ;�.r � i <br /> � .;�.� <br /> Service Address - " Utility Account No. „ � � <br /> Billing Address ' '•'� + '% Connection Permit Fee ' <br /> City,State, Zip-"� � r r r , - �.� ;-, • •' � / Connection Fee <br /> , <br /> � ; <br /> Owner (Mortgagor) � ; �•..- Total Fee - - <br /> Billing Name . � =�i�:- <br /> �, � � <br /> _ Connection By F � ` > <br /> r <br /> A' !' � <br /> Address � i� ' i i-:. _ �: Signed ; �; <br /> � � � Customer '-,,,�,°?_::' <br /> Phone ' '�� ` ' '�`' � <br /> DESCRIPTION: Sewer District <br /> Lot � � � � � <br /> Block Monthly Sewer Service t� <br /> Division or Addition 'f �/ • ' ��� : Nionthly Sewer Constc ��� � <br /> Trunk <br /> Type PermiC <br /> Lateral <br /> Remarkr. <br /> ' - " Abutting Lot Line <br /> , � �. „ .. ,.__�__�—: ,�. — P N, S, E, W ft. <br /> /� � t G w SA _ . ' <br /> _J,f/ /Y oF / <,.iT Na �vs ,E�Tie.✓. <br /> Approved By_ �'�� ' � <br /> fJ� H/S (� ' 'i e li — �✓ S e'A z Ciry Enginecr �, <br /> E no i.v E <i I <br /> Issued By <br /> o�isE _ <br /> /�%,C.6, <br /> C i' 6 <br /> _ Inspection By � ;`n�" <br /> r:= <br /> Datelnspected <br /> a <br /> SEE SI(ETCH ATTACHED NO. �^-_ Q 9 6 j � ! <br /> INSPECTION " ' '"' "` "' ' <br /> Engineenng U -,t <br /> < � <br /> ,;a <br />