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evere� <br /> � - <br /> City of Everett <br /> Engineering Department <br /> SEwer �►pplic�tiora and �ermit � <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 /> Customcr <br /> Phone <br /> DESCRIPTION: Sewer District_ _ <br /> L�t��� o� Monthly Sewer Service <br /> elock_,�'� <br /> D�vision or Addition Monthly Sewer Constr. <br /> — Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Let Line �, <br /> N, S, E, W ft. <br /> --� <br /> Approved By � <br /> City Engineer <br /> Issued BY--_—_ ' <br /> Inspection By ��"�-"-'�'�--� <br /> Date Inspected 3�0/7 ) _ <br /> 0 <br /> SEE SKETCH ATTACHED NO. � �� `� � <br /> t <br />