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,�_� <br /> 8 <br /> everett �'m s ✓ L'` � ,� <br /> e _ � <br /> �'d �p .-Z�'= S <br /> City of Everett 6 _ � � � � i � <br /> Engineering Department �� `� { <br /> i <br /> Sewer AppEication and Permit � <br /> N0. _ _ ._ � � DATE <br /> Service Address 2�z, c-���c��,� Utility Account No. - <br /> Billing Address Connection Permit Fee — <br /> City,State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing tdame <br /> I <br /> Connection By • <br /> Address Signed ' <br /> cu�tomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Mo�thly Sewer Service <br /> Block <br /> Division or Addition —Monthly Sewer Constr. <br /> Trunk <br /> Type Perrriit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N $, E, yy ft. <br /> � <br /> Approved By � <br /> Ciry Enpineer � <br /> issued By � <br /> � � 2 . .s <br /> s ,t�2� II <br /> Inspection By <br /> Dateinspected <br /> 3 — Z � 7 � <br /> � SEE SKETCH ATTACHED N�• 212 E � �I <br /> INSPECTION <br />