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\ <br /> e"verett , , �� �`� � !' <br /> � �-.�j i;/ 'i. <br /> � " �, � � � � q���, �� �� � <br /> � - j <br /> City of Everett <br /> Engineering Department <br /> Sewer Applicction and Perrmit <br /> No. 210 2 � DATE � _ <br /> Service Address Utility Account No. <br /> Billing Address . Connection Permit Fee � ' <br /> City, State, Zip ' Conn=ction Fee_ <br /> Owner (Mortgagor) Total 1=ee <br /> Billing Name � <br /> Connection By <br /> Address _ Signed__._. <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> 81ock _ Monthly Sewer Service <br /> Division or Additio� Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral_ <br /> Remarks: s <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By._, <br /> City EnBinecr <br /> Issued By <br /> Inspection By , //���. ,��-�-�+�� <br /> Date Inspected_ � � i s' <br /> 0 <br /> SEE SKETCH ATTACHED NO. ? '� (� '� � <br /> .:i I��"u! <br />