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✓rv�'� <br /> •�verett ��S <br /> � � ZD ^ Z� _ S� <br /> ;� -- /L -- 7 :G <br /> City of Everett � � <br /> Engineering Department ��� /L � <br /> SewQr Application and Permit <br /> f' ` ' � DATE <br /> No. 1 ,_ c� .L <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 Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> . Ciry Enpincer . <br /> Issued By <br /> Inspection By — <br /> Date I nspected g"'/��% <br /> a <br /> SEE SKETCH ATTACHED �`1�• i' L � � � <br /> �PECTI ; I <br />