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everett <br /> � �� ��c. <br /> . � � _ �, <br /> City of Everett <br /> Engineering Department � . <br /> S�vver �►ppl�e�tion and Permit <br /> N0. _ _ DATE __�7 <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee 1 � <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) _ _ Total Fee_ � v � � <br /> Billing Name <br /> Connection By _ <br /> Address Signed _ <br /> Cuuomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot ,? -� 8 <br /> Block .3 �3 �c � Monthly Sewer Service <br /> Division or Addition L����� B�� P Monthly Sewer Constr. <br /> Type Fermit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By_ <br /> City Engincc' <br /> Issued By <br /> Inspection dy <br /> p Date Inspected�" <br /> SEESKETCH ATTACHED N� <br />