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everett <br /> � „ . <br /> � ; r ` <br /> ! �-< � �' <br /> '� � �. � ,�� � .� � <br /> City of Everett -- <br /> Engineering Department <br /> Sewer �4g�plicatian and P�rmit � <br /> � � ��64 � <br /> NO. � G G U � DATE - <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 /> Division or Addition Monihly Sewer Constr. <br /> Type Permit: <br /> Trunk <br /> � Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Engineer ' <br /> Issued By <br /> /1 �'� <br /> Inspection By�L <br /> i <br /> Q Date lnspected___� "! ��_ <br /> SEE SKETCH ATTACHED NO. '; 'f; �� (1 �' <br />