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:'.P " <br /> ever�t � _ ' <br /> �- � J � � - � , i , - <br /> � —�, �-,.�-�r �� `i��c� /7s <br /> � �`i�� <br /> City of Everett �� <br /> Engineering Department <br /> Sewer Applic�tion and P�rmit <br /> No. 210 2. 6 DATE _ � � <br /> , <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 /> Connection By <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTIQN: Sewer District � <br /> Lot <br /> 0 <br /> Block _ Monthiy Sewer Service � <br /> Division or Addition . Monthly Sewer Constr. <br /> - Trunk � � o� <br /> Type Permit: <br /> Lateral ---- <br /> Remarks: � '�c•..,�r, �i�^,E As `',c,���: <br /> Abutting Lot Line <br /> _ ' N, S, E. W ft. <br /> — Approved By_. <br /> Ciry Engincer <br /> ----- Issued By _ <br /> -- '.ispection By�'.�.Z�r-+ ������P� <br /> — / <br /> __ __ Date Insperted � � <br /> • o <br /> SEE SKETCH :.TTACHED NO. � ] �J ? � <br /> f�;. . �� Iln�� <br /> —r:i <br />