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evereft % - i � ,� <br /> -�- , ���.;;�� � <br /> � ��_ . _n _ 2`i _ �� ;�, .� i ,t <br /> ' C � <br /> City of Everett <br /> Enpineering Depertment <br /> Sewer Application and Permit �,j �:15 <br /> N0. 2OH5 � DATE ^ ��� �% _: � ! / � ;- - <br /> ServiceAddress - ^ "� � '-:` ?:_r'-T__ UtilityAccountNo. _ <br /> Billing Address % � � r:' Connection Permit Fee� ' - <br /> City, State, 2ip -�' �= � ' � = �-r Connection Fee <br /> Owner (Mortgagorl� � ;-l. ; ' i' I /. ', Total Fee - <br /> Billing Name r_; r- _ <br /> Connection By� 7 � �;- ;,�,;_ �. � �; <br /> Address Signed ' � � c , ; I l i�� � - <br /> " Cwtamer �-' <br /> Phone - __ <br /> DESCRIPTION: Sewer District <br /> Lot�Y�_ <br /> Block .l� Mo�thly Sewer Service_ <br /> i <br /> Division or Add'+tion � ' - �Monthly Sewer Canstr. <br /> Type Permit: — Trunk <br /> � , � , <br /> �' , <br /> Lateral <br /> Remarks: _ - <br /> - Abutting L�t Line <br /> � - - N, S, E, W_ ft. <br /> � � ,, ; i, , . ,, . .. ... ,., _ , .� — <br /> . , _. ,:, . � i�.. '. , .�,� : � ,�:::. <br /> , l, . . � , . _ ., _ . ., . . , / „ <br /> — Appraved By...,y. , _ <br /> Ciry EnBineer <br /> Issued By • <br /> Inspection 8y_ — <br /> Datelnspected_ __ _ __ __ <br /> o— <br /> SEE SKETCH ATTACHED N0. ;' ,1 }? r� �� <br /> � �ir� � , <br />