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everett <br /> � " G -Zc� -7 :-; <br /> City of Everett � � �� � ` � I <br /> Engineering Department �,� , _� - <br /> './,_i c<,;:'. <br /> Sewer e4pplication cand Peranifi� � <br /> N0. _. _' .. . _ DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zi,� _ 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 /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk _ � <br /> Lateral <br /> Remarks: <br /> Abu?ting Lot Line <br /> _ N, S, E, W_ ft. <br /> �2/--,5[�Gr r� g�� i7i'-,7�� t�t' <br /> 6Q--.�7��O <br /> Approved By <br /> i � - ' City Engincer <br /> Issued By <br /> Inspection By <br /> 0 <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. ' <br /> , ;; . <br />