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V � <br /> everett , a , , � �� <br /> � � ` � � `� <br /> � �� � � j'j <br /> i <br /> ; < <br /> ;� <br /> City of Everett <br /> Engineering Department ��`� <br /> Sewer App�ication a�nd Perrt�it <br /> N0. ` : ;, '_ DP.TE <br /> � _�� v �� <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee_ <br /> Owner (Mortgagor) Total ree <br /> Billing Name_ <br /> Connection By � <br /> Addres� " Signed _ — <br /> � Cus�om^_r <br /> Phone <br /> DESCRIPTION: Sewer District — <br /> Lot <br /> Monthly Sewer Service <br /> Block - .. <br /> Division or Addition - _Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: " ;�, w- '� <br /> Lateral <br /> Remarks: nw,✓�i� iys i,�p 4 zs y�i <br /> Abutting Lot Line <br /> ��_ N S, E, v�/ _ft. <br /> � � <br /> / <br /> i <br /> / Approved By_ � — <br /> �. > Ciry Engineer <br /> ISSUE(J By <br /> Inspection By <br /> Date Inspected <br /> 3 <br /> SEE SKETCH ATTACHED NO. <br />