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rCVt. .,�l /�.;. ..- .� ��_J <br /> I ✓ � <br /> � s- re- Zq -y- <br /> City of Everett <br /> ; _ z3 - � � <br /> Enyineering Oepartment � �� <br /> ;� ,��/ <br /> Se�er Appli�tation and Perr�it ` �� <br /> N0. _ L _' ,; ,' ^ DATE — <br /> Service Addressll'+�/"� Utility Account No. — <br /> Billing Address �"-' <br /> Connection Permit Fee '� ° ' `� '���j <br /> � _ <br /> City, State, Zip i� %'f '- ' Connection Fee - <br /> Owner (Mortgagor) � ' - � '',�t'a�r: `� TotalFee '� ' <br /> � <br /> Billing Name , <br /> r <br /> Connection By Y jdl.f'! ;: , <br /> f ' � <br /> Address Signed �'` ', c��come� <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot._ Monthly Sewer Service <br /> Biock_ <br /> Division or Addition � � ' -- Monthly Sewer Constr. <br /> Trunk <br /> Typr. Permit: ' <br /> ., <br /> , � � Lateral <br /> Remark.: - _ Abutting Lot Line <br /> ,./ ' , N, g, E, W ft. <br /> �:�` � - -- <br /> �� / <br /> Approved By <br /> City Engineer <br /> Issued By <br /> Inspection By <br /> Datelnspected <br /> � SEE SKETCH ATTACHED N0. 2�,�, 'rj nL <br /> �SPEG I i.?N <br />