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evere� <br /> e ����- ��; � <br /> City of Everett 2 5 — r� r L� <br /> Engineering Qepartment � � <br /> Sewer Application and Permit <br /> N0. c. J- J � ' UATE <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 /> Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type PermiL <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By � � <br /> City Engineer <br /> — Issued By <br /> Inspection By ���L��� <br /> Date lnspected '�L7�� 7 <br /> v <br /> SEE SKETCH ATTACHED No. 215 3 � <br /> WSPECTION <br />