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- i <br /> everett I <br /> e <br /> , <br /> City of Everett � � <br /> Engineering Uepartment <br /> Sewe Applicat�' an Permit <br /> \ , � <br /> \ � -; 3& 73 <br /> NO. 2 Q 9 DATE ` ' � ' ' <br /> ,-✓ _ - -- <br /> Service Address � % %� <"'G,� •" >' Utility P,ccount No. <br /> Billing Address � '� �'C '� %%ii rL'C- �- r-� Connection Permit Fee_ `--- <br /> City, State, Zip �'��`` ���%'� - � •' • �� Connection Fee <br /> Owner (Mort a or) ' c":.< ;" '� ' <br /> 9 9 , Total Fee - /� <br /> Billing Name ' �" <br /> - ���t.c.� �� '�� i <br /> Connection By ' " �� i��'.-; : � <br /> Address %�` ��i ,�- �,' Signed <br /> Cusromer <br /> Phone ' <br /> DESCRIPTION: Sewer pistrict. <br /> Lot <br /> Block �: � ' Monthly Sewer Service <br /> _ C' ." <br /> Division or Addition - / f' ' r J- .._.�7 Monthly Sewer Constr. <br /> Type Permit: � � `:� Trunk <br /> �/ c'i .;( <br /> ILateral <br /> Remarks: ,Tfr NEN C•B. W PaNNE� ,fp To 6Yi5Ti✓G <br /> Abutt�ng Lot Line <br /> Hn!'•,vc i E 4ir g � OF �✓� ce,v!`, /i/.r. IV� V� C� W (t. <br /> QE/fy AT O•n'rccTi� 2� <br /> Approved By � <br /> Ciry Enpineer <br /> Issued Ry ' - <br /> Inspection By �1��f �`��� <br /> o Date Inspected /��i���. <br /> SEE SKETCH ATTACHED N�• G U �7.j � <br /> INSP[CTIOK <br />� <br />