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everett ��.��� <br /> e _ _ ,�� <br /> , � 7—Z ��s <br /> '� _ . - - <br /> City of Everett <br /> Engineering Department <br /> Sewer p►pplication and Permit <br /> NO. L i (� F' � DATE � '� � I <br /> Service Address Q�-� �/��� 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 /> DESCRIPTION: Sewer District <br /> Lot�— Monthly Sewer Service <br /> Bio�k 5'- <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Engineer , <br /> Issued By <br /> Inspection By <br /> � � <br /> Date Inspected S��7�� ' <br /> e SEE SKETCH ATTACHED \ No. 21 G � 1 <br /> '°:;; 'cCTIOi� <br /> --c� __� <br />