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everett ' ' <br /> e �_ _� ., _ , <br /> rv . <br /> �y`' J v I �- L �i V <br /> City of Everett <br /> Engineering Department � - 2` 7� <br /> Sewer Application and Permit <br /> N0. r. .i. �l .�.. .� DATE �e '� ., ; _ <br /> i <br /> Service Address� �,Q� ,- � ►2L�n(,�1R� Utility Account No. <br /> Billing Address Connection Permit Fee %�. ' <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) � -_ 7otal Fee � �` � ^`�' <br /> Billing Name �'� <br /> Connection By — -- - <br /> ./ <br /> Address ' � - Signed ' � ��'" � " , , <br /> � � Cu�tomer � <br /> Phone — <br /> DESCRIPTION: Sewer District ^ ' - _ _ <br /> Lot 4 } � �� <br /> � � Monthly Sewer Service � -�;:; <br /> Block 2 U <br /> Division or Addition r�.���F� ��/ Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: [� <br /> ,� � Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> Approved By <br /> CityEnginear� . <br /> Issued By ' <br /> Inspection By '�r ��'L``'�'' <br /> Date I nspected 3��d�7� <br /> e <br /> SEE SKETCH ATTACHED No. 21613 <br /> INSPECTION <br />