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everen <br /> e <br /> City oi Everett <br /> Enpineerinp Department <br /> Sewer Application and Permit ', <br /> NO. DATE I _ _ <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip _ Connection Fee <br /> Owner (Mortgayor) Total Fee _. <br /> Billing Name <br /> Connection By_ <br /> Address Signed <br /> CuftOrtllf <br /> Phone_ <br /> DESCRIPTION: Sewer District_ <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition ., Monthly Sewer Consir. <br /> -- Trunk <br /> Type Permit: <br /> ' Lateral <br /> Remerks: f- ,,, � <br /> _ Abutting Lot Line <br /> � N• S• E� W ---ft. <br /> Appraved By — <br /> City Enpineer <br /> — ISSUCd By <br /> Inspection By <br /> o-- <br /> ___ Date Inspected - <br /> SEE SKETCH ATTACHED N�• , � � � �� ! ! � <br />