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everctl I -- I <br /> � � � , � <br /> � <br /> � <br /> -�,;<C: <br /> City of Everett ' <br /> Enpineering Department I <br /> Sewer Appfication cnd Perrr�it '� <br /> � �� i �f � � <br /> No. 2 0 5 9 6 DATE � <br /> Service Address�_ Utility Account No. <br /> Billing Address _ Connection Permit Fee <br /> City, State, Zip ' ' Connection Fee <br /> Owner (Mortgagor) � ��i Total Fee_ - - <br /> Billing Name <br /> Connection By � - <br /> Address - ---� Signed _ <br /> cusromer <br /> Phone _�_ — <br /> DESCRIPTION: Sewer District __ _ <br /> Lot ' <br /> Block_T� <br /> Monthly Sewer Service___ . <br /> Division or Addition �- Monthly Sewer Constr. <br /> Type Permit: Trunk _ <br /> _ —___.�_. , <br /> .' <br /> Lateral <br /> Remarks: <br /> --- Abutting Lot Line <br /> __ N, S, E, W ft. <br /> U-Q����_� � /�� �� / J/ <br /> _A.c�.�1 ha�- a. /a. .QC��- -- <br /> Approved By <br /> City Engine�r ' <br /> -- Issued By <br /> Inspection By �� �-���`'`�—' <br /> ___ — Date Insper,ted tj��%� <br /> a <br /> SEE SKETCH ATTACHED NO. "� (� �� �? (� <br />