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everetl ;' z�— r�,�_ <br /> � _- '`�._.c�- <br /> ,p_ <br /> / <br /> City of Everett <br /> Engineering Oepartment �r� <br /> Sewer Application and Permit <br /> NO. � _'. �'. � ':: DATE , <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner IMortgagor) Total Fee i <br /> Billing Name <br /> Connection By ! <br /> Address __ _ Signed <br /> Cuotomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Menthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: �� �,� ,� /s E,C' ,FTt'iY Abutting Lot Line <br /> N, S, E, W it. <br /> Approved By <br /> CitV EnBineer . <br /> Issued By <br /> InspectionBy�W� �"""`"� <br /> Date Inspected����/�� <br /> e SEE SKETCH ATTACHED No. 21176 <br /> ",;PECTION � <br />