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1 <br /> everett �� _ ' �L�� • ' ,� � � " `� -� 7 � <br /> � ' 4. <br /> � ., <br /> � <br /> �i h : �� 1�:,i�: <br /> City of Everett <br /> Engineeriny Department <br /> Sewer Applicction and Permit <br /> . . � <br /> .� ,; .-: ht. <br /> No. 2 0 G 10 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 /> �.�� ���"��)�IL �;/,�aJ .'. ��:V;; , �,,Ci� /NL <br /> Connection By � <br /> Address Signed �', 'r � '�=��-vrw. „ <br /> c�,�o�� ' <br /> Phone — <br /> DESCR'°TION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Perniit - <br /> Lateral_ <br /> Remarks: <br /> — Abutting Lot Line <br /> ___ N, S, E, W__ _ft. <br /> � S,o � . <br /> Approved By <br /> City cnBinem <br /> Issued By _ <br /> InspectionBy �' C�'-��'�`(Q"J <br /> _ Date Inspected N Z �/? U <br /> Y <br /> SEc SKETCH ATTACHED N0. ;�' f 1 {�, � (1 I <br /> . ....� <br />� <br />� <br />