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everetl <br /> e r ^ _ <br /> .� <br /> �;• - !7 - ' '�, -� � �.���✓���,; �"%� RECEI V <br /> EQ <br /> City of Everett <br /> Enpineerinp Depertment ��� 11 19T4 <br /> �ENGINFFn�;� d ��',; '- c,� <br /> Sewer Application and Permit � � ° <br /> n,o. 20838 DATE ,�:' , �' � , _ L � •34�]') <br /> Service Address ' ' � <. � ',., ' <br /> Utility Account No._ <br /> Billing Address�f'�- 'f ` <br /> Connection Permit Fee____ <br /> CitV, State, Zip �_ ' i' i . � <br /> Connection Fee <br /> Owner (Mortgagor�_ � <�r' ; � ' Total Fee ' <br /> BillingName =.�T '�� �— � <br /> , <br /> Connectiun By ' � , • <br /> Address % <br /> . Signed <br /> Phone ` ' i , c��ro�r <br /> DESCRIPTI ON: <br /> Lot_ C.! SewerDistrict <br /> Black_ Monthly Sewer Service <br /> Division or Addition � � <br /> Monthly Sewer Constr. <br /> Tvpe Permit: ' � ; ; Trunk <br /> ��:�!�_; <br /> Lateral <br /> Remarks: . <br /> ' ' Abutting Lo[ Line <br /> N, S, E, W _ft. <br /> �" J ' ' ' APProved By <br /> Ciry Enpmeer <br /> Issued By <br /> Inspection By __ <br /> o — — — Datelnspected <br /> SEE SKFTCH ATTACHED ND• ; �� �3 H <br />