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� <br /> 'ee•e•„t: <br /> � � � ':� .�w �i .�� <br /> �'�° �,3 <br /> City of Everett . <br /> Engineering Department � <br /> �Se�nnr�er Application an�d Perrrtit I <br /> N0. DATE <br /> Service Address <br /> Utility Account No. <br /> Billing Address i . <br /> Connection Permit Fee <br /> City, State, Zip <br /> Connection Fee <br /> Owner (Mortgagor) <br /> Total Fee <br /> Billing Name <br /> Connection B�.i <br /> Address ;. . <br /> Signed <br /> PhO�e � � � � � ._ Customer <br /> DESCRIPTION: <br /> Lot Sewer District <br /> ----_ <br /> Block Mor.'hly Sewer Service <br /> Division or Addition <br /> Monthly Sewer Cunstr. <br /> Type Permit: Trunk <br /> Remarks: � �� <br /> Lateral <br /> �z �F �f C. I rif'E- <,Gi / <br /> — , �� � Abutting Lot Line <br /> F Nnr,.=� Aot�E� a,v N, S, E, W <br /> i� – .�o � n� � " ��vc ft. <br /> '�, <br /> � /� C:N Tc� E /SY�A/G � <br /> C°L/J G_ <br /> 1JT iJtGF i �� — <br /> Approved By <br /> City Engineer <br /> Issued By <br /> �� � � � � <br /> Inspection By�� /3�Y <br /> � <br /> 3 Date Inspected z 7� <br /> SEESKETCH ATTACHED � <br /> NO. „ .� �, ., .-, <br />