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everen <br /> e y ^ <br /> ,� <br /> City of Everett <br /> Enpineerinp Department <br /> Sewer Application cnd Permit <br /> NO. Di�TE <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 /> Cu{tomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot — <br /> Block Monthly Sewer Service_ ___ _ ._ <br /> Division or Addition _ Monthly Sewer Constr. <br /> �ype Permit: Trunk <br /> _ Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> .. � , � <br /> N, S, E, W ft. <br /> Approved By <br /> C�Iy Enpinea <br /> Issued By <br /> , T_ <br /> Inspection By��t ': r--ru�.� <br /> o------------ — Date Inspected ������7 <br /> SEE SKETCH ATTACHED NO. ' ' <br />