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l I <br /> everett <br /> � j � � ����.5 <br /> City of Everett <br /> �� <br /> Engineering Department �/� GU�2�� �Cs1/ � <br /> Sewer �4pplication and Permit ��; �,. s �; �'�iz` - <br /> NO. � _ DATE — <br /> Service Address � y��5 ��.���—�-- 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 Siyned <br /> Cusromer <br /> Phone <br /> DESCRIPTION: Sewer District_ <br /> Lot 3 Monthly Sewer Service_ <br /> Block �'S�� <br /> Division or Addition�L L) i- �F GI/,�/z t7T Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: � <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> Ciry Erginccr <br /> Issued By <br /> Inspection By <br /> Datelnspected - <br /> 3 <br /> SEE SKETCH ATTACHED N0. ' ' , <br />