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.'\ I <br /> everett <br /> � <br /> _ _ F� � <br /> City of Fverett ,,�� � � _ � ,� _ <br /> Engineering Department � ^ �_ <br /> 5ewer Appiicc�tion cand Perrr�it � <br /> NO. �� _ _ DATE � <br /> Service Address L Utility Account No._ <br /> Biiling Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> O�vner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Cusmmer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot ,� <br /> Block ��� Monthly Sewer Service <br /> Division or Addition f�=/a 7- n r Fi/6/Ir' �� Monthly Sewer Constr. <br /> Type Permit: 5 . Trunk _ <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> _ N, S, E, W ft. <br /> .:: <br /> Approved By <br /> Ciry Engincer <br /> Issued By <br /> Inspection By <br /> o Date I nspected ' <br /> SEE SKETCH ATTACHED Np, � "; � `? `> <br />