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_ .. „ . <br /> everett <br /> � �' ° ` . .�'S �G( <br /> City of Everett � 3� ' 2 � ' � <br /> Engineering Department � /_,. <br /> � / ? 6 i % <br /> Sewer Application and Permit <br /> N0. '.. '_ ` DATE <br /> Service Address�/2.�,/:G. f� ��� 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 Signad <br /> Customer <br /> Phone <br /> DESCRIPTION: aewer District <br /> �ot N�% w�Lf4!� <br /> Block s L Monthly Sewer Service <br /> Division or Addition_ �� � r Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> /� N, S, E, W ft. <br /> �.��LA '^�✓wl.Qit. <br /> Approved By <br /> City EnBinecr <br /> Issued By <br /> Inspection By�� �-�a�� <br /> e Date Inspected�/�S� � Z _ <br /> SEE SKETCH ATTACHED No. ?161 g <br /> INSPECTION <br />