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� everett , ' � G�� j I <br /> ,/ - L- 1 -� �, r <br /> � n ✓' / > <br /> '"i �ir ' • �. �� ti� � � ' /J <br /> : ir�,t/1 <br /> !_ <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit�g``� <br /> No. 21066 DATE - � <br /> Service Address - r � ' � � ' Utility Account No. % �/ '�"i: ) <br /> Billing Address ' ' - Connection Permit Fee `' � � ' <br /> , —-- , <br /> Y, p � � Connection Fee <br /> Cit State, Zi � - ' <br /> Owner (Mortgagor) � %��� �����- Total Fee ��`��. �� � <br /> Billing Name_ —_ <br /> ' - <br /> Connection By � � '`" %�1 �� .'� ��i , <br /> Address�^r ' �J'�/ i'�`� Signed <br /> Customer <br /> Phone � � <br /> DESCRIPTION: SewerDistrict /�'�'r'��%r /�% <br /> Lot %�� <br /> Block Monthly Sewer Service_�"" <br /> Division or Addition �Z�}C�r'''� i:' �� �:'rl/= % ' Monthly Sewer Constr. <br /> i' � <br /> Type Permit: , � � ,,, ,�__ � � Trunk <br /> i <br /> . ,` / . ; . � Lateral _ _. <br /> Remarks: �� ' � 95 �,� s <br /> Abutting Lot Line <br /> N S E W _ _ . -- ft. <br /> Approved By_. % ,�i -' <br /> c��v e���o��� <br /> , <br /> Issued By _ <br /> Inspection By �//-i� i?%�t-si� <br /> a -- Datelnspected_ � Z 6 75� <br /> SEE SKETCH ATTACHED No� 210 6 6 <br /> ;P[CTI O N <br />