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everett � -;,^� <br /> � � � jJ-- � _. <br /> City of Everett <br /> Enpineerinp Department <br /> Sewer Applicct�on and Permit <br /> N0. 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 By <br /> Address Signed <br /> C��stomer � <br /> Phone _ _ <br /> DESCRIPTION: Sewer District <br /> Lot_ <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> .� <br /> Approved By <br /> _ City Enpineur <br /> Issued 8y <br /> ,� � C� <br /> ____ Inspection By �-'{ 2Z�Gt.--� <br /> p ---- ------ Date I nspected /�^Z/�7�_ <br /> SEE SKETCH ATTACHED NO. <br />