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everett '�O„S/ � 'b <br /> ef_2d -' Z � .- S <br /> City of Everett � — Z � 7 ,^� <br /> Enpineering Department � � � <br /> Sewer Application and Permit <br /> „ � -- <br /> N0. r _ ;_ �. ; DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection Dy <br /> Address_ Signed <br /> cu:tomer <br /> Phone_ ' <br /> DESCRIPTION: Sewer District _ <br /> Lot <br /> Block Manthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> 1 N, S, E, W ft. <br /> �. '--�—.F . . <br /> , . :� <br /> :' <br /> , � ' , ' <br /> ;� . ,f <br /> Appro�ed By <br /> City Engineer <br /> Issued By <br /> Inspection By C�, i3.2o s s �� i> <br /> Date I nspected 3 - z- � — 7 6 <br /> a <br /> SEE SKETCH,ATTACHED N0. �1, 2 8 7 <br /> i�SPECTION <br />