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everett <br />.� <br />City of Everett <br />Engineering Ueaartment <br />�"'_' r' '� - .� <br />_ 'I� j� ���cn % 27�7�� l���i„- <br />i <br />Sewrer Application and Perm�t <br />NO. 2067� DATE ,i ..,- � �� ; .-�:.,' <br />Service Address Sl• Utility Account No. <br />Billing Address Connection ?ermit Fee..._ <br />City, State, Zip - Connection Fee - <br />Owner (Mortgagor) �- I I� i Total Fee ' <br />Billing Name __ — <br />- , . �;,: <br />Connection By - — <br />Addres,—.... ': ,-- -. ._ - Signed—`-- ; : ,.,_. ;; <br />- � ' Customer � <br />Phone - <br />DESCRIPTIUN: Sewer District <br />Lot <br />Monthh� Sewer Service <br />Block <br />Divisicn or Addition _ Monthly Se�ver Constr. <br />Tvne Permit: . .. . .. <br />— Trunk <br />Lateral <br />3 <br />SEE SKETCH ATTACHED <br />,.'ECT;ON <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enginecr <br />Issued <br />Inspection 6y -�J� - <br />Date Ir�snected 7 � i,'-� <br />No. r(;r �r; <br />0 <br />