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i <br /> .� <br /> -everett � s' %L <br /> � �� � � ^?�`5 <br /> � — zs — 7� <br /> City of Everett <br /> Engineering Department �c�� � <br /> Sewer A�aplication anr� Permit <br /> N0. �-� ��- -- -�� '�� 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 � � �0�� � <br /> Lot <br /> Block Monthly Sewer Service M '��2� 0. <br /> Division or Addition � " �, Monthly Sewer Constr. <br /> Trunk �' � S <br /> Type Permit: -- <br /> Lateral �� �Z `� <br /> Remarks: � �i���. � p��, , � <br /> Abuttin Lot Line � � <br /> �, E, W. ft. <br /> Approved By <br /> City Engincer <br /> ISSUECJ By <br /> Inspection By__--C��� �� <br /> __ Date Inspected /��=%%� <br /> a— <br /> SEE SKETCH A7TACHED NO. � ��_ 7 �. �; <br /> . .. _ _ � . <br /> ' /' , <br /> 7F ' 1 . . . . � � . . . � ' � � .. � .. . .. .. . . . .. _' <br /> t� � , <br />