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evere� <br /> � <br /> City of Everett <br /> Engineerinp Depertment <br /> Sewer Application arod Permit <br /> N0. i '_ DATE _. — - - <br /> Service Address Utility Account No. — <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee_ <br /> Owner (Ulortgagor) _ Total Fee <br /> Billing Name — <br /> Connection By <br /> Address _ Signed c���� <br /> Phone <br /> DESCRIPTION: Sewer District , <br /> Lot�� Monthly Sewer Service <br /> Block <br /> Division or Addition _—Monthly Sewer Constr. <br /> Trunk <br /> Type Permi:: <br /> Lateral__ <br /> Remarks: T��,a �2� �y��n/ i%. l3/,�r/_?� Abutting Lot Line <br /> - � N, S, E, W ft. <br /> � <br /> a � <br /> � 1 .��iiJi��-� ��O � <br /> �_�}�L�?i'�'tfr� �ri7 - • [���'7 <br /> �_ �/'����'�_ • <br /> � - — Approved By <br /> � ��—' w ' � Ciry Enpinex <br /> /�i/IV <br /> _ Issued By <br /> Inspection By — <br /> Date Inspected � <br /> � SEE SKETCH ATTAGHED No. ; 1 2 l 1 <br /> � � � , , <br />