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` � everett -� •; .z - . 5� 1 � ' ' <br /> � � � ._ <br /> _: ., _ ;, <br /> City of Everett <br /> Engineering Oepartment <br /> n,� <br /> Sev�rer Applicafiion anc� Permit - <br /> NO. _ DATE <br /> Service Address Utility Account No. <br /> Billing Address_ Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (M�rtgagor) 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 5ervice _ <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> � � �� C�� N, S, E. W ft. <br /> Approved By <br /> City Engineer <br /> -- issued By <br /> Inspection By <br /> 3-- Date Inspected <br /> SEESKETCH ATTACHED yp, <br />