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everett <br /> � y <br /> �i��`�� - <br /> City of �verett <br /> Engineering Department <br /> � <br /> 5ewer i4pplieai�ion and Permit <br /> NO. j 9 �f � � DATE I <br /> Service Address _ 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 Signed <br /> Customer <br /> Phone _ <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Jivision or Addition Aqonthly Sewer Coristr. <br /> Type Permit: Trunk_ <br /> Lateral_ <br /> Remarks: <br /> Abutting Lot Line <br /> PJ, S, E, W ft. <br /> ( .—, <br /> Approved By_. <br /> ' Ciry Engincer <br /> r <br /> i � � � !:= , . - � , — , Issued By <br /> „_ ; . _ . , . <br /> _ : � ,. . <br /> _ , . . - . �7 go Inspection By— � �"-6�,�`���\ <br /> � � __ Date I nspected �s ;�-d ' 7 S <br /> � SEE SKETCH ATTACHED / � �3/ f�lp. i ; ' , � <br /> � <br />