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evrren ' �7Q S �'�'d <br /> e � - 3 , _ 2� � � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. r_ �-', ;:' � DATE <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 /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> n N, S, E, W ft. <br /> �� �f�'��� <br /> r <br /> Approved By <br /> City Engincer <br /> Issued By <br /> � <br /> Inspection By� ' ������---• <br /> o Date I nspected_ �1�3f 7 �o <br /> SEE SKETCH ATTACHED NO. �� �1 �� '"� <br /> li'JSPECTIOi': <br /> , <br />