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/ %�Y • <br /> everett , . �-- <br /> � - -- � `t - ZB - S <br /> City of Everett ' Z"� ✓ , ' <br /> Engineering �epartment , <br /> Sewer �►pplicai�ion and �ermit <br /> NO. _ . DAT[ <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 Monthly Sewer Constr. <br /> Type Permit: — Trunk <br /> Lateral <br /> Remarks: ��__� ,5���� <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Engineer <br /> Issued By_ <br /> � <br /> � <br /> Inspection By— z.� L�' <br /> � Date Inspected ���� <br /> SEE SKETCH ATTACHED NO. <br /> ,; , _ <br />