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eveFett <br /> � . ' .. /, _ `� . <br /> City of Everett � <br /> Enpineerinp Depertment <br /> + r <br /> Sewer Application and Permit �3 4 ,, ; f; <br /> No. 2pg57` 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 /> cu:tomer <br /> Phone <br /> DESCRIPTION: <br /> Sewer District � <br /> Lot �+ � <br /> Monthly Sewer Service <br /> Block "' <br /> Division cr Addition Monthly Sewer Constr. <br /> ' Trunk — <br /> Type Permit: � <br /> Lateral <br /> Remarks Abutting Lot Line <br /> —�1s? - _ N, S, E, W ft. <br /> ' // <br /> Appraved By_ <br /> /'7 (i �-r^ �t� ��_� CityEnBineer <br /> (/ /\ LC <br /> Issued By <br /> Inspection By � ` ' <br /> Date I nspected�� " �'S <br /> 0 <br /> SEE SKETCH ATTACHED NO. �� (I ` !i j <br /> � : � ,�i <br /> 1 <br /> � <br />